Insurance/Credit card authorization form

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Hersheydmd
Posts: 686
Joined: Sun May 03, 2009 9:12 pm

Insurance/Credit card authorization form

Post by Hersheydmd » Mon Oct 31, 2016 4:25 pm

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.
Last edited by Hersheydmd on Tue Jul 18, 2017 8:12 pm, edited 1 time in total.
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
https://www.facebook.com/pages/Robert-M ... 1471599429

rhaber123
Posts: 330
Joined: Fri Dec 11, 2009 1:09 pm

Re: Credit card authorization form

Post by rhaber123 » Wed Feb 01, 2017 11:39 am


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Hersheydmd
Posts: 686
Joined: Sun May 03, 2009 9:12 pm

Re: Insurance & Credit card authorization form

Post by Hersheydmd » Tue Jul 18, 2017 8:08 pm

Here is my insurance/credit card authorization form:
2017-07-18.png
2017-07-18.png (122.02 KiB) Viewed 5802 times
Insur_auth-and-credit_card.xml
(32.43 KiB) Downloaded 386 times
Robert M Hersh DMD, FAGD
Univ. of Penn 1982
Brooklyn, NY 11234
https://www.facebook.com/pages/Robert-M ... 1471599429

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