Payment Authorization Form

$20.00

What is it? This is a Payment Authorization Form, which allows you to hold patient payment information on file in order to charge for services rendered, or any other legal debts such as no-shows or missed appointments.

Who is it for? For all providers and business providers to have a way to legally keep their clients payment or patient information on file and charge for cancellations and missed appointments.

When do I use it? Before first payment.

Why do I need it? This form allows you to hold private payment information of your patient legally. Depending on your intake form it also provides payment protection for missed appointments. 

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