Credit Card Payment

If you have a current balance due at Midwest Eye Care or wish to prepay for an elective surgery, please fill out the form below to make a secure payment. Please be sure to include all of your contact information in the payment order form so that we can contact you quickly if we have any questions.
  • Patient Information

  • Payment Method

  • MasterCard
  • Please click the Submit button below only once to process your payment. You will receive an email confirmation once your payment has been received.