*This authorization shall also apply to our billing agency that is covered under a confidentiality agreement with NCCT as well as a HIPAA Business Associates Agreement.
Please note that NCCT shall keep the above information confidential. NCCT shall use all reasonable efforts to preserve the secrecy and confidentiality of the above information. NCCT shall not disclose such confidential information to any third party outside of NCCT's practice.
Effective 10/1/2012 Signature of NCCT Credit Card Processing Form is required of all NCCT clients.