ADA Accessibility Information
Accessibility
A
A
A

Layer Dental Payment Form

Please fill out the form below. Required fields are marked with asterisks (*).

 

Contact Information

Patient's First Name: *

Patient's Last Name: *

Patient's Account #: *

Address:

City:

State:

ZIP:

Home Phone:

Other Phone:

Email Address: *

 

Payment and Credit Card Information

Please enter your payment amount and credit card information below.

Name on Card

Card Type

Visa MasterCard Amex Discover  

Payment Amount ($):

Credit Card Number:

Expiration Month

Expiration Year

CVV Number (on back of card):

 

Thank you for paying your bill online. You will receive a confirmation email and a receipt for your payment.

 
 
 

It may take a moment to submit your information. Please wait for a confirmation message.








Insurance Assistance
We work with all insurance carriers, with the exception of the Oregon Health Plan.

For more information please see our financial options.


Patient Forms

Click to go to the patients forms page

Payment Plans Available (OAC)
CareCredit is a personal line of credit for healthcare treatments and procedures for your entire family. It works like a credit card, but can only be used for healthcare services.

Home  | Hygiene  | Restorative  | Financials  | Forms  | eNewsletter  | Team  | Dr. Layer  | Testimonials  | Contact Us  | Promotion




Jacob O. Layer DMD, PC | www.layerdental.com | 541-734-0970
1485 East McAndrews Rd., Medford, OR 97504



 

 

Copyright © 2011-2017 Jacob O. Layer DMD, PC and WEO MEDIA. All rights reserved.  Sitemap | Links
Jacob O. Layer DMD, PC, 1485 East McAndrews Rd., Medford, OR, 97504-6107 - Associated Words: dentist Medford OR : dentist Medford OR : 541-734-0970 : www.layerdental.com : 9/22/2017