Credit/Debit Card Authorization Form

Please fill out the form provided with information regarding a debit or credit card you want to use to hold your appointment spot. Failure to do this within 24 hours of booking could result in a loss of appointment space. We do require a card to be on file in order to save your appointment. Any information provided is guaranteed to be 100% encrypted for your protection and will not be shared or given to anyone or any other company. 

Use also this link for fillable version.