Collect Payment Information With the Payment Authorization Form

The Payment Authorization Form allows you to collect a payment method from your client that can be used for practice charges and fees. This form requests your client's credit card details and electronic authorization securely through the client portal. Once submitted, the credit card is authorized with our credit card processor and automatically put on file in the client's Billing Settings, ready to be charged!

You must have portal document sharing and credit card processing enabled in order to use this form.

Tip: Any user can preview this form in your practice's Library, and Practice Administrators can edit the Acknowledgement statement to suit your practice's needs. To do so, click Library > Portal Forms tab > Payment Authorization Form. Click the Edit icon on the preview to edit the Acknowledgement statement, then click the Save Changes button.

Role Required: Any

To share the Payment Authorization Form with a client:

Click Patients > Patient name > Portal tab
In the Portal Requests and Shared Documents section, click the Share Documents button.
The Share Documents on Portal dialog appears. With the Library Documents tab selected, begin typing "Payment Authorization Form" in the Select Library Documents to Share field.
TherapyNotes will generate a list of possible matches as you type. Click on the form from this list to add it to the request.
Add other documents to the request if desired, and enter Instructions for your request.
Click the Send Document Request button.

Once your request is sent, your client will receive an email notification informing them that there is paperwork that is ready for them to complete.

After your client has submitted their completed form, their new credit card information will be added automatically to their Billing Settings without any additional processing. The completed form can be viewed on their Documents tab.

You can share the same form with a client as many times as needed. However, if you want to share the form with a client again before they have completed the initial request, you must first cancel the initial request before sending the form again. For more information on sharing documents with your clients, read Share Documents With Clients on TherapyPortal.