Practice Policies | Credit Cards

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ALL Intake forms must be completed and signed, or we cannot process your account, or schedule an initial intake appointment!

The Credit Card Authorization form must be filled out regardless of insurance coverage.

Patients with insurance coverage are still directly financially responsible for the no show, cancellation & late reschedule charges described under the "Payment & Cancellation" section of our intake form titled, "Informed Consent To Telemedicine".

Your credit card will NEVER be charged unless one of the above situations has occurred. Our company policy does not allow us to process any account without Credit Card Verification.

Any missing forms will result in the delay, or denial of any appointments, referrals, or services until we receive the forms fully completed.

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