make a payment

At Eye Surgery Center of Westchester, we strive to make our patients’ experience as easy and convenient as possible.

If you are pre-paying for an upcoming procedure please click the button below to visit our pre-payment form.

* Required Field

Patient Name*

Payment Amount*
Amount to be paid (do not include $ sign)
$

Account Number*

Date of Service*(mm/dd/yy)

First Name*

Middle Name

Last Name*

Address*

Address 2

City*

State*

Zip*

Country

Phone Number

Email Address*

A receipt will be sent to this email address.

Card Type*

Card Number*

CVV/CVC Number*

Exp. Month*

Exp. Year*

refund policy:

If you have made a payment via the online web portal, you may request a refund to your credit card for the following reasons:

Customer transaction error
- Incorrect amount
- Paying the wrong provider
- Wrong credit card used
Duplicate payment