NOTE: TELEPHONE, EMAIL, & PATIENT NAME ARE REQUIRED TO SUCCESSFULLY PROCESS A PAYMENT

If you are paying an invoice/statement for multiple patients, please include all patient names in the Patient Name field to allow us to properly credit your account. Any additional relevant information can be included in the Comments field, if needed.

Online payment can be made via a US Bank Account or a Credit/Debit card.

If you have questions or need assistance, please call/text us at 248-634-2301 or email hello@hollydentistry.com. Thank you!

Amount (USD $)
Billing Information
Additional Information
Comments