Common Contracts

1 similar File Agreement contracts

Credit Card On File Agreement
File Agreement • April 26th, 2016

We have implemented a policy which enables you to maintain your credit card information securely on file with Bright Hearts Counseling (BHC). In providing us with your credit card information, you are giving BHC permission to automatically charge your credit card on file for your (or any other patient(s) you have listed on this form) co-pays/co-insurance, outstanding balances,

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