Skip to main content
Open Menu
KR PERIO
Call us today at
305-652-2255
North Miami Beach Florida
Home
Patient Information
Welcome
First Visit
Patient Registration
Scheduling
Financial Policy
Insurance
Infection Control
Advanced Technology
Oral Sedation
Home Instructions
Photo Gallery
Online Payment
Treatments
Dental Implants
Tooth Extractions
Gum Disease Laser Therapy
Bone Grafts for Regeneration
Gum Grafts
Esthetic Smile Surgery
Biological Aids for Regeneration
LANAP
LAPIP
Dental Health
Oral Hygiene
Prophylaxis (Teeth Cleaning)
Dental Dictionary
Periodontal Maintenance
Arestin
Why you are seeing a Periodontist
Meet Us
Meet Dr. Katherine Rodriguez
Contact Us
Home
/
Patient Information
/
Online Payment
Online Payment
Online Payment Form
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Payment Amount
*
Credit Card
*
American Express
Discover
MasterCard
Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Expiration Date
Security Code
Cardholder Name
Total
$0.00
Address
This field is for validation purposes and should be left unchanged.
Δ
Scroll to top
Close Menu
View Full Menu
305-652-2255
North Miami Beach Florida
×
Contact Us Today
Your Full Name
Your E-mail Address
*
Your Phone Number
How did you hear about us?
Questions/Comments?
Δ
privacy policy
305-652-2255
North Miami Beach Florida
×
Request A Visit
Your Full Name
*
Your Phone Number
*
Your Email Address
*
Are you a new patient?
Yes
No
Date
Date Format: MM slash DD slash YYYY
Morning
Afternoon
Please describe the reason for your visit.
Δ
privacy policy
Click to open and close visual accessibility options. The options include increasing font-size and color contrast.
Black Text on White
Increase Font Size
Decrease Font Size
Reset Font Styles