Consent Form - Credit card on file policy

Z Medi Clinics and Z Medi Spa

At Z Med Clinic and Z Medi Spa we require keeping your credit or debit card on file for cancellation/ no-show fees of $25 for appointments missed or canceled within a 24-hour period.

Your credit card information is kept confidential and secure and payments to your card are processed only after the claim has been filed and processed by your insurer. This document will be shredded once completed.

I am aware that I will lose one of my laser hair removal sessions for all the areas booked if I no show or cancel within the 24 hours and there is no card on file.

I authorize Z Med Clinic and Z Medi Spa LLC to charge the following credit or debit card:

Full Name

Date

Phone

Select Your Preferd Location

I (we), the undersigned, authorize and request Z Medi Spa to charge my credit card, indicated above, for balances due for services/cancellations rendered that is my financial responsibility. This authorization will remain in effect until I (we) cancel this authorization. - Signature

Sign here