Billing Account Request

Request for Account Balance, Confirmation of Payment Made, or Copy of Statement.

Please fill out the following information and click on “Submit”. Your request will be processed within 2 business days. Contact the Business Office at 937-320-5055 for questions. Please note, all fields must be filled out in order to process your request.

Account Information Request

Billing Accout Request

*Patient Name:

*Patient DOB (Month/Day/Year):

*Account #:

*Your Email Address:

*Your Request (Please state "Last Payment Made" if you would like confirmation)



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Dayton Gastroenterology, Inc.

  • Beavercreek (Sylvania) Office & Endoscopy Center - 75 Sylvania Drive, Beavercreek, OH 45440 Phone: 937-320-5050 Fax: 937-320-5060
  • Beavercreek (Indian Ripple) Office & Endoscopy Center - 4200 Indian Ripple Road, Beavercreek, OH 45440 Phone: 937-320-5050 Fax: 937-320-5060
  • Englewood Office & Endoscopy Center - 9000 N. Main Street Suite 405, Englewood, OH 45415 Phone: 937-320-5050 Fax: 937-320-5060
  • Miamisburg Office - 415 Byers Road Suite 100, Miamisburg, OH 45342 Phone: 937-320-5050 Fax: 937-320-5060

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