Thank you for choosing us for your foot and ankle care! Please complete the form below; on the next page you will be asked to select the date and time for your reservation. Name* First Last Email* Phone*AppointmentCredit Card* American ExpressMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name San Mateo Podiatry Group stores credit cards securely to cover incidental expenses such as copayments and deductibles. By submitting this form, you agree to the Office and Financial Policies of San Mateo Podiatry Group. Industry-standard encryption is used to protect the confidentiality of your personal information.