I, (client or parent/guardian), authorize Poppy’s Therapeutic Corner to charge my credit card via the Square App or Ivy Pay App 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 school, 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.