Forms and Payments
20+ Years of Experience | Medicaid Accepted | Locally Owned Practice
20+ Years of ExperienceMedicaid AcceptedLocally Owned Practice
Our Patient Forms
Ahead of your first visit to Sumrall Dental Clinic, we ask that you print and fill out the following forms. This will save you time and lessen your waiting time before your appointment.
Payment Options
You may submit your payment to Sumrall Dental Clinic by mail with your payment stub or online via PayPal. You can also set up a payment plan using CareCredit.
Call 601-758-0150
to schedule your appointment.