$0.99 USD

Credit Card Authorization Form

This straightforward credit card authorization form allows clinics to securely collect and charge patient credit card information for programs, treatments, or ongoing services. Designed for licensed functional, aesthetic, and concierge practices, the form includes fields for cardholder name, billing frequency, card type, expiration date, and signature. It supports automated billing and integration with your POS system while maintaining patient trust and clear financial communication.

Download now to streamline your billing process and ensure secure, documented consent for recurring payments.

What People Are Saying:

This credit card authorization form is clear, compliant, and easy to incorporate into our onboarding process. It gives us the ability to securely charge for services and programs while maintaining transparency with our patients. A must-have for any practice offering recurring or package-based care.

Lauren M., NP | Functional Wellness Practice Owner