HSO Webpay

Brighton Park Dental

4441 S Kedzie Ave
Chicago, IL

(773) 847-1260

Statement ID

If you have a statement, you may enter the Statement ID found in the upper left corner. (Optional)

Patient Details

Enter the patient’s information below to ensure this payment is applied to the proper account.

Last Name

Last Name

Date of Birth

Date of Birth

Cardholder Details

Zip Code

Zip Code

Phone Number

Phone Number

Payment Amount

Payment Amount

(R) Product of QuickBill Premium