Pay - Houston Pediatric Dental Specialists

Request Appointment

For your convenience, we now offer the ability to securely pay online.

Patient Name(Required)

First Last

Patient # (Optional)

Billing Contact Name(Required)

First Last

Email(Required)

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Location your child was seen at

Enter amount you will be paying(Required)

Total

Optional note to accompany your payment

Credit Card

Card Details

Cardholder Name