Accepting Credit Cards? You Need An Authorization Form

Are you a mental health counselor in private practice (or heading in that direction)? If so, then you need a…

Credit Card Authorization Form

What exactly is a credit card authorization form? And why do you need one in your private practice intake forms?

A credit card authorization form allows you to charge your client’s credit card on an ongoing basis , which includes session charges, as well as late cancellation/no-show charges (and if you don’t have a Late Cancellation/No-Show policy in place by now, make sure you do!).

Having a form for authorizing electronic payments is vital — after all, you need to make money, right?

Luckily, we happen to know a thing or two about counselor intake forms. Here are some key point to make sure you include in your own credit card authorization form:
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1. Explain how your practice stores your client’s payment information (e.g., “an electronic, HIPAA-secure card-on-file system,” such as Ivy Pay)
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2. In your credit card authorization form, state that it is the client’s responsibility to inform you of any payment changes that need to be made prior to session (including concerns regarding inability to pay)
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3. To ensure continuity of services, note that the cardholder must agree not to dispute fee charges
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4. Note that the credit card authorization form applies to all session fees, late cancellation charges, and current and future outstanding charges

Need Intake Forms For Your Practice?

Writing a credit card authorization form can be tricky. But rest assured, we’ve got you covered. Check out our high quality, comprehensive, therapist-approved Easy Intake Packet, which includes the credit card authorization form along with 7 other must-have forms for your private practice.