Open Dental Forum

Posted: **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.

Posted: **Wed Feb 01, 2017 10:39 am**

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

Posted: **Tue Jul 18, 2017 8:08 pm**

Here is my insurance/credit card authorization form:

: 2017-07-18.png (122.02 KiB) Viewed 137780 times

Insur_auth-and-credit_card.xml: (32.43 KiB) Downloaded 8054 times

Open Dental Forum

Insurance/Credit card authorization form

Insurance/Credit card authorization form

Re: Credit card authorization form

Re: Insurance & Credit card authorization form