Forms & Payments

Business Hours
Mon - Thu7:30 am - 5:00 pm
Fri - SunClosed
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Forms and Payments

20+ Years of Experience | Medicaid Accepted | Locally Owned Practice

20+ Years of Experience
Medicaid Accepted
Locally 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.
Online payment

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.
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