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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

$2.99 Regular Price
$0.00Sale Price
  • Purchase includes digital downloads in the following formats:

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

678-765-9291

1431 Riverside Pkwy, Suite A

Lawrenceville, GA 30043

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Freedom Path Counseling is a registered 501(c)3 organization. Tax ID # 83-2210496. Your donations to Freedom Path Counseling are tax deductible to the fullest extent allowed by law.

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