Credit Card Authorization Form
To update your credit card on file, download and complete the authorization form below. Be sure to provide a valid cardholder signature. We are unable to accept forms with typed names in the signature field.
Unable to print? Copies of this form are now available in our lobby.
FORM SUBMISSION OPTIONS
- Fax: 972-499-6935
- Email: email@example.com
- Direct: at your next appointment