Dental Bill Payment

Thank you for your payment, and thank you for choosing MIT Health.
Allow three business days for your payment to be processed.

Statement Details

Statement Date

Chart #

Patient Name

Responsible Party

Total Amount

First Name

Last Name

Street Address 1

Street Address 2

City

State/Province

Please enter State/Province code (e.g. MA)

Postal Code

Country

Phone Number

Email Address

Upon submission you will be directed to a secure form to enter your payment details.