(408) 729-8111 | 

PATIENT PORTAL | 

APPOINTMENT

safe and secure
Making a payment through our Website is secure, your payment will be processed through secure merchant service (Paypal). You'll need to fill out the correct info in the below online form. Please make sure to enter the correct amount we asked you to pay it or as showing in your bill.

 

(All fields are required)

 

 Patient Full Name:*
 
  Patient Date of Birth:*
 
 
 
 Enter the Amount to Pay:*
+ 3% of total amount (credit card payment convenience Fee) will be added.
Note: We accept all major credit cards to pay online, No Paypal account is required and the payment process is secure with a 256-bit Secure Sockets Layer encryption. SSL encryption is indicated on your Web browser by the display of a lock or key on the browser status bar. Please read our Program and Cancellation policy.