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Credit Card Authorization

 

Utilize the handy form to validate consent to charge patient credit cards. This form can also serve as consent to place a credit card on file for future changes, without the card needing to be present.

Credit Card Authorization Form

$2.99 Regular Price
$2.69Sale Price
  • Purchase includes digital downloads in the following formats:

    • Microsoft Word (editable)
    • Pages for Mac (editable)
    • PDF
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