Payment Options Acceptance Form
Form Template
The Payment Options Acceptance Form mobile app provides a simple way to notify patients about the acceptable payment methods in a dental or medical practice.
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Use the form to let patients know how they can pay for your services and have them sign off electronically to confirm their agreement with the listed terms.
The form can be customized to include different types of payments, including credit cards, debit cards, money orders, checks, fixed fee payment plans or direct draws from an account. Once completed, the signed form can be saved electronically for your records.
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