• Patient Policies
    • Welcome Letter
    • Patient Information
    • Financial Policy
    • Charity Policy
    • Billing Procedure
    • Estimate Request
    • Privacy Policy
  • Practice Forms
    • New Patient Registration
    • Installment Plan
    • Financial Hardship Application
  • FAQ
  • Survey
  • Make a Payment
    • Pay by CC
    • Pay by ECheck
    • CC Mail In
    • ECheck Mail In
    • Payment Plan CC
    • Payment Plan ECheck
    • CC Deposit
    • ECheck Deposit
    •      
     

    Patient Billing Online Bill Pay

    		  
     
    		 
      Deposit Payment by ECheck  
         
     

    I HEREBY AUTHORIZE Midlands Anesthesiology to initiate charges to my checking account in the amount specified below:

    Please allow 3-5 days to process, your confirmation will be emailed to the email address you provide below.

    		  
     
    Patient First Name: *
    Patient Last Name: *
    Account Number: *
    Re-enter Account Number: *
     
    PAYMENT INFORMATION:
    Payment Amount: *
    Routing Number: *
    Checking Account Number: *
    Check Number: *
    Account Holder Name: *
    Billing Address: *
    City: *
    State: *
    Postal Code: *
    ADDITIONAL INFORMATION:
    Email Address:
    Phone Number:
    Surgeon Name:
    Surgery Date:
       
     
     

     
       
    		 
     


    If you have any questions please contact us:

    Midlands Anesthesiology
    Attn: Billing Department
    PO Box 1427
    Columbia, SC 29202

    Phone: 803-765-1838

    MA@patient-billing.com

    		  
     

     

     

     

     

     

     
      Copyright © PTBill. All Rights Reserved.