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Available Forms

Payment Form

Online Bill/Copay Payment

Please use this form to pay your bill or copay for Valley Oak Family Practice.This information is securely sent directly to our office. Once the information is received one of our office staff will run your payment.

If you are prepaying your copay for a virtual visit we will not run your card until the day of your appointment.

Patient Information

First & Last

Card Information

Please indicate the dollar amount you authorize Valley Oak Family Practice to charge to your card.
Name on credit/debit card

Receipt

Depending on your selection above, please provide us with either your email address, phone number, or mailing address. Please fill out this information accurately to ensure we can deliver receipt to you.
* Required field