You can always press Enter⏎ to continue
Lane Orthodontics Payment Form
Payments made easy
  • 1
    Press
    Enter
  • 2
    If you would like amount to be applied to multiple patients please leave a note under "Additional Requests"
    prevnext( X )
    USD
    Enter Amount
    Payment Methods
    creditcard
    cashApp
    After submitting the form, you will be redirected to the Cash App Pay to complete the payment process.
    googlePay
    After submitting the form, you will be redirected to the Google Pay to complete the payment process.
    applePay
    After submitting the form, you will be redirected to the Apple Pay to complete the payment.
    Press
    Enter
  • 3
    A confirmation of payment and receipt will be sent here
    Press
    Enter
  • 4
    example: Need FSA receipt, Apply payment to additional children, etc.
    Press
    Enter
  • Should be Empty:
hipaa badge
Question Label
1 of 4See AllGo Back
close