Secure Payment Form
By submitting the form below, I agree to have my credit card billed by Ambulatory Surgery Center of Western New York for the amount I have indicated. I further submit I am the primary cardholder or authorized user on the below account.
Select Transaction Type
Accepted Payment Methods:
(enter number without spaces)
in US dollars
Patient Account Number
(If different from payee below)
Name and address information below must match the billing information for the credit card or the transaction will not go through.
Please answer the simple math problem below:
E-mail billing questions to
Ambulatory Surgery Center of Western New York
3112 Sheridan Drive • Amherst, NY 14226
Click here for a map and directions.
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