Common Contracts

2 similar Credit Card on File Agreement contracts

CREDIT CARD ON FILE AGREEMENT
Credit Card on File Agreement • March 29th, 2023

Triangle Family Dentistry is implementing a new credit card on file policy effective February 2023. Like many other dental and medical practices, we have adopted a similar policy. We kindly request our patient’s guardian/guarantor provide a credit card which will be used to pay a balance. Co-pays are still due at the time of service. Your credit card information will be obtained and kept securely on file.

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CREDIT CARD ON FILE AGREEMENT
Credit Card on File Agreement • January 25th, 2023

Triangle Family Dentistry is implementing a new credit card on file policy effective February 2023. Like many other dental and medical practices, we have adopted a similar policy. We kindly request our patient’s guardian/guarantor provide a credit card which will be used to pay a balance. Co-pays are still due at the time of service. Your credit card information will be obtained and kept securely on file.

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