Open Dental Forum • Credit card authorization form

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Credit card authorization form

Posted: Wed Feb 01, 2017 10:41 am

by rhaber123

Hersheydmd wrote:Does anyone have a credit card authorization form? I already have a recurring payment authorization form, but I need a form for the balance after insurance pays. Thanks in advance.

check this form and make your own:
http://imaging.ubmmedica.com/all/editor ... POLICY.pdf

Re: Credit card authorization form

Posted: Sun Feb 12, 2017 2:48 pm

by Third Coast

That form is great, thank you.