Patient Notebook

GLENDALE SURGICAL CENTER

824 North Glendale Avenue

Glendale, CA 91206

Phone: (805) 879 - 9005

Test Mode Activated. Any transaction attempted will not be processed.

Make a Payment

Need to make a payment? Please fill out the information below and hit continue.

Error Summary

Please, correctly fill out all required fields.

1. Patient Information

First Name *

M.I.

Last Name *

Account Number *

Email Address *

A receipt will be sent to this email address.

2. Payment Amount

Amount

3. Payment Method

Credit/Debit Card

Name on Card *

Card Number *

Expiration Date *

Security Code *

Zip Code *

Cancel