I, {cardholderName}, as a cardholder, hereby authorize Integrity Doctors or Living Well Labs of Florida to charge my credit card for the Screening Leads Web Software program and confirm that the information for the credit card and/or billing information is complete and accurate. Once submitted it may take up to 4 weeks for creation of your personalized account. Our representatives will contact you via email when your custom survey is ready.
I also acknowledge that I can cancel this service and it's recurring payment with at least 15 days notice by emailing apphelp@integritydoctors.com.