To send your payment information to our office, pleaes click here. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information.
Our online form uses Adobe Acrobat Reader 9 or greater plug-in to conveniently submit the form from home or work. Please download the free plug-in from Adobe's web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe's web site.
Shimane Oral and Maxillofacial Surgery | 20406 Redwood Road, Suite G, Castro Valley, CA 94546 | T 510.885.8720 | F 510.885.8724
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