Please complete this form to allow The Institute for Optimal Healing & Aesthetics to use your credit card for today's visit and or any upcoming visits, services or products. You may elect to provide us with credit card information separately for each payment or use Cash, Venmo or Cashapp to avoid the 3.25% CC transaction fee Please be aware that even if you elect to use Venmo or Cashapp we still need your credit card on file. We have a strict no show policy and for this reason we need a CC on file to hold any appointments.
I authorize The Institute for Optimal Healing & Aesthetics to charge the credit card account on file ending in for payments owed to my account for services and products rendered or ordered at their office.I agree to update any information regarding this account. The above information is complete and correct to the best of my knowledge. All credit card companies charge transactional fees to cover expenses for reward programs and consumer incentives. This convenience fee is paid directly from the card user to our third-party processor, Clover Payment Processing. The Institute for Optimal Healing & Aesthetics does not receive any part of this fee.Thank you.
2701 W Oakland Park Blvd, Ste 335 Oakland Park, FL 33311