Payment Terms & Conditions

I/We do hereby agree to pay to Oklahoma Surgical Hospital the amount due according to the terms listed. The amount due represents charges incurred for services at Oklahoma Surgical Hospital on the date of the procedure(s).

Should payments not be made under the terms of this agreement, I understand that any unpaid amounts could be referred to an outside collection agency. I further understand that the Facility’s Business Office is to be notified of any changes in my residence, phone number, or the credit card/banking information I submitted and approved for automatic monthly payments on this payment plan. The Business Office can be reached Monday – Friday 8am – 5pm at 918-477-5012 or customerservice@oksurg.com.

I understand that this form is valid unless I cancel through written notice to the facility the authorization to use my credit card/checking/saving account for the automatic monthly payments of this payment plan.

Electronic check/bank transfer payments will take 2 to 3 business days to be processed. Payments that occur on the weekends or holidays will be processed on the next business day.