Make a Payment

To make a one-time payment, please fill out the information below. If you wish to set up recurring payments or if you have a question on your account, please contact the Dental Clinic at 720-777-6788.

Customer Information

Dental Invoice Information

(*) Required Fields. To edit any added information, please click on that column and press 'Enter' once done.

Credit Card Information

Card Holder Information



(*) Required Fields

Submit Clear