Dogwood Emergency and Internal Medicine Clients Only: Use this form to place deposits and other payments for treatment.

For payments to all other specialty services, please contact them directly.

Please complete the information below and click submit. You will be automatically forwarded to a secure page where your payment information will be collected and processed. If you have any questions please call 804-716-4700.

Online Payment Form
First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Phone:
Email:
Quantity:
Patient Name
Amount