I, (client or parent/guardian), authorize Poppy’s Therapeutic Corner to charge my credit card via the Square, Ivy Pay or Theranest after each session.
I authorize Poppy’s Therapeutic Corner, LLC to charge my credit card in the case of an emergency (imminent risk of harm to self or others).
If services are office or telebased, I understand that I will not be present every time my card is billed. I understand that I need to notify my therapist in writing to discontinue services and for my credit card to stop being charged for services. I understand that my information will be saved to file for future transactions on my account.