As the cardholder and person responsible for recurring session copays or session fees, hereby authorize Acorn & Oak LLC  to charge my credit card for session copays or session fees at the time of service or anytime thereafter if there is a balance due.  

I confirm that the information for the credit card and billing address is complete and accurate, and I will update this information if anything changes.

I have been informed that I can cancel the recurring payment at least 14 days before the payment by emailing Acorn & Oak at officeadmin@acornoakmaine.com.