Patient Notebook

St Marks Outpatient Surgery Center

1250 East 3900 South

Ste 100

Salt Lake City, UT 84124

Phone: (801) 262 - 0358

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 *

Patient Account Number

Date of Service *

Phone Number *

Date

Email Address

A receipt will be sent to this email address.

2. Payment Amount

Amount

3. Payment Method

Credit/Debit Card

Bank Account

Name on Card *

Card Number *

Expiration Date *

Security Code *

Zip Code *

Cancel

P (801) 262 - 0358

1250 East 3900 South Ste 100

Salt Lake City, UT 84124