Bill Payment For Demo for Dental Office                                                        Back to main demo page

  Bill Payment Form for Dental Office sample example Welcome to...
PEARL DENTAL'S
 Patient Bill Payment Form
.

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Now you can pay your dental bill day or night.  Just enter your Patient ID and Balance Due and click continue. 
Thank you for your Payment.
- Drs. George and Sandi Pearl and Pearl Dental Staff.

Welcome to our...
DENTAL CAFE

Did You Know?

The habit of grinding and clenching the teeth is known as bruxism.

Here, people with irregular or infrequent bruxism do no get affected as much. It does not really show the damage done to the jaws and teeth. It is those who are habitual grinders who get affected. In severe cases it can also damage one’s jaw or hearing.

The question arises as to how would one know if he or she grinds or clenches their teeth? If detected how bruxism can be treated? It has been studied that some people make a noise when grinding their teeth thus making it detectable while some do not make a single sound making it hard to detect.
There are two ways one can know if they have bruxism, first is when your partner complains about it and second is when after a night’s sleep you get up with an ache in your jaws or a slight, persistent headache. Whatever the case, a checkup by the dentist is pertinent.

NEXT MONTH:  GUM DISEASE

 

Welcome to PEARL DENTAL
Patient Bill Payment Form.
 

INSTRUCTIONS: Locate the invoice number and the balance due found on the statement or the email we sent you.  Enter them onto the form below.

Quantity Enter your Invoice Number Below

Invoice Payment
Amount Due

1

By clicking CONTINUE, you will be sent to our SECURE PAYMENT FORM

=====TEST DRIVE THIS FORM =====
Enter any text and $ amount.  Next, press CONTINUE.  
Next page: Enter TEST Credit Card Number: 4111111111111111 
expiration: 12/12  cvv2: 555 on secure billing form.

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