Financial & Payment Policies Compliance Bundle

A complete, editable bundle designed to help private practices, clinics, and solo providers clearly communicate financial policies, protect revenue, and maintain client trust.

Includes six professional, customizable forms:

• Payment Authorization and No-Show Fee Agreement – outlines payment expectations and fees for missed appointments.

• Advanced Credit Card Authorization Form – secure consent for recurring or high-value charges.

• Credit Card Authorization Form – standard authorization for one-time or recurring billing.

• Financial Hardship Sliding Scale Application – formal process to assess and document sliding scale eligibility.

• Universal Good Faith Estimate – comply with federal requirements for cost transparency (No Surprises Act).

• Payment and Insurance Policy Acknowledgement – ensures clients understand and accept your payment policies upfront.

Benefits:
✔ Supports clear, documented communication with clients
✔ Reduces payment disputes and late cancellations
✔ Helps ensure legal and ethical compliance
✔ Fully editable templates for easy customization with your branding