I authorize the Ketamine Healing Clinic of Los Angeles and Orange County to charge the credit or debit card indicated in this authorization form $200. I certify that I am an authorized user of this credit card, and that I will not dispute the payment with my credit card company so long as the transaction corresponds to the terms indicated in this form. I understand there is a 48 hour weekday cancellation policy requiring me to inform the Ketamine Healing Clinic that I cannot keep an appointment. In case of no shows or cancellation within 48 hours of your first appointment, the deposit is forfeited.