{"id":180452,"date":"2026-08-17T08:23:52","date_gmt":"2026-08-17T08:23:52","guid":{"rendered":"https:\/\/pabau.com\/?p=180452"},"modified":"2026-08-18T13:40:13","modified_gmt":"2026-08-18T13:40:13","slug":"credit-card-authorization","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/templates\/credit-card-authorization\/","title":{"rendered":"Credit card authorization form"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"Credit card authorization form\",\"description\":\"Download a free one-page credit card authorization form template (PDF) for medical practices. Includes a field checklist, sample wording, and PCI DSS and HIPAA guidance.\",\"url\":\"https:\/\/pabau.com\/templates\/credit-card-authorization\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"mainEntity\":{\"@type\":\"DigitalDocument\",\"name\":\"Credit card authorization form\",\"description\":\"A printable one-page credit card authorization sheet with an open authorization details area, a signature line, and a date line for the cardholder to complete.\",\"encodingFormat\":\"application\/pdf\",\"url\":\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/templates\/credit-card-authorization\/credit-card-authorization.pdf\",\"inLanguage\":\"en\",\"isAccessibleForFree\":true,\"offers\":{\"@type\":\"Offer\",\"price\":\"0\",\"priceCurrency\":\"USD\",\"availability\":\"https:\/\/schema.org\/InStock\"},\"hasDigitalDocumentPermission\":{\"@type\":\"DigitalDocumentPermission\",\"permissionType\":\"https:\/\/schema.org\/ReadPermission\"},\"author\":{\"@type\":\"Organization\",\"name\":\"Pabau\",\"url\":\"https:\/\/www.pabau.com\"},\"datePublished\":\"2026-08-17\"},\"datePublished\":\"2026-08-17\",\"dateModified\":\"2026-08-17\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>A credit card authorization form records a patient&#8217;s written consent to charge their card for treatment, deposits, or late-cancellation fees.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The template above is a one-page sheet with an open authorization details area, a signature line, and a date line.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Before you hand it to a patient, write in the cardholder name, card details, billing address, amount, purpose, and payment schedule.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>PCI DSS bars you from keeping the security code once the charge is authorized, and HIPAA covers the form because it documents payment for care.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau collects the same consent online, so no signed sheet has to be filed, retrieved, or shredded.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<div style=\"background: linear-gradient(135deg, #E2F2FD 0%, #DFE3FD 100%); border-radius: 16px; padding: 40px; margin: 32px 0;\">\n<h2 style=\"margin: 0 0 12px 0; font-size: 22px; color: #121d36;\">Download your free credit card authorization form<\/h2>\n<p style=\"margin: 0 0 20px 0; color: #444; font-size: 15px;\">A printable one-page sheet with an open Authorization details area, a signature line, and a date line. You add the card details, amount, and payment terms yourself, using the field checklist and sample wording below.<\/p>\n<a style=\"display: inline-block; background: #037CD2; color: #fff; padding: 14px 28px; border-radius: 8px; text-decoration: none; font-weight: 600; font-size: 15px;\" href=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/templates\/credit-card-authorization\/credit-card-authorization.pdf\" target=\"_blank\" rel=\"noopener\">Download template<\/a>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Card details scribbled on paper, or a verbal yes with nothing on file, both cost you money later. Missed deposits, unbilled no-shows, and chargebacks nobody can defend all trace back to the same missing signature.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A credit card authorization form is the written record that a cardholder agreed to a charge. It names the card, the amount, the reason, and the schedule, and the patient signs it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The template above gives you that signature page. This guide covers what to write on it and how the three authorization types differ. It also shows where PCI DSS and HIPAA apply to a medical practice.<\/p>\n\n\n\n<h2 id=\"h-what-is-a-credit-card-authorization-form\" class=\"wp-block-heading\">What is a credit card authorization form?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A credit card authorization form is a document that gives your practice written permission to charge a patient&#8217;s card. It captures the cardholder&#8217;s consent before any money moves, and it stays on file as proof.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That record does two jobs at once. It shows the patient agreed to a specific amount on specific terms. It also gives you something to submit if the charge is disputed months later.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In aesthetics, dermatology, and med spa settings the form usually covers more than a single visit. Deposits, multi-session packages, and late-cancellation fees are all <a href=\"https:\/\/pabau.com\/blog\/self-pay-patients\/\">self-pay charges<\/a> that need consent captured in advance.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Payment habits vary by specialty. <a href=\"https:\/\/pabau.com\/industry\/laser-clinic-software\/\">Laser practices<\/a> in particular run on deposits and package plans. The template works across specialties and across all three authorization types.<\/p>\n\n\n\n<h2 id=\"h-what-the-downloadable-template-includes\" class=\"wp-block-heading\">What the downloadable template includes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The template is a single printable page. It carries the form title, an open Authorization details area, a signature line, and a date line in day, month, year order.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The authorization details area is deliberately blank rather than split into labeled boxes. That keeps one sheet usable for a one-time deposit, a recurring treatment plan, or card-on-file consent.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It also means the sheet is not ready to hand out as-is. There is no printed field for the card number, expiration date, or billing address, so you write those details into the blank area yourself.<\/p>\n\n\n\n<h3 id=\"h-sample-wording-for-the-authorization-details-area\" class=\"wp-block-heading\">Sample wording for the authorization details area<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Copy the wording below into the blank area, then swap in the details of the charge you are authorizing:<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"wp-block-paragraph\">I, [cardholder name], authorize [practice name] to charge the card below.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Card: Visa ending 4242. Expiration 09\/28. Billing address: 14 Oak Street, Austin, TX 78701.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Charge: $150 deposit for a laser consultation, taken once on 09\/14\/2026.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">I understand a $50 fee applies if I cancel less than 48 hours before the appointment.<\/p>\n<\/blockquote>\n\n\n\n<p class=\"wp-block-paragraph\">Collect the security code separately, on a slip you destroy the moment the charge goes through. Once the payment is authorized, cross out everything but the last four digits of the card number on your file copy.<\/p>\n\n\n\n<h2 id=\"h-what-to-include-on-the-form\" class=\"wp-block-heading\">What to include on the form<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A completed authorization form has to capture four things: the cardholder, the card, the charge, and the consent. Use the checklist below when you fill in the blank template, or when you build a headed version of your own.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Required<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Why<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Cardholder name<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Identifies who is authorizing the charge, and shows whether the payer is the patient or someone else.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Card number<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Needed to process the payment. Mask all but the last four digits on any copy you keep.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Expiration date<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Confirms the card is still valid, and flags recurring plans that will outlast it.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Security code (CVV)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes, for the first charge<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Shows the cardholder had the card in hand. It must not be stored once the authorization completes, under PCI DSS Requirement 3.3.1.2.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billing address<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lets the address verification check run, which lowers your risk of a fraudulent card being used.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Authorization amount<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Caps what the patient has agreed to. Anything above the stated figure needs fresh consent.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Purpose of the charge<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Names the treatment, deposit, or fee being paid for, which is what wins a dispute.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Payment schedule<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes, if recurring<\/td>\n<td style=\"padding:12px 16px;color:#374151\">States how often the card will be charged and for how long. Card network rules expect this in writing.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Cardholder signature and date<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Turns the sheet into evidence of consent. The template provides both lines already.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>One rule worth printing on the wall:<\/strong> delete the security code as soon as the charge is authorized. PCI DSS treats it as <a href=\"https:\/\/www.pcisecuritystandards.org\/standards\/pci-dss\/\" target=\"_blank\" rel=\"nofollow noopener\">sensitive authentication data<\/a>, so an encrypted copy is not permitted either. <a href=\"https:\/\/pabau.com\/features\/payment-processing\/\">Pabau&#8217;s integrated payment processing<\/a> passes the card straight to the processor, so the full number never lands in your own records.<\/p>\n\n\n\n<h2 id=\"h-how-to-use-the-form-with-a-patient\" class=\"wp-block-heading\">How to use the form with a patient<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Using the form well takes five steps, and the fifth one matters long after the charge clears:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Give the patient the form before the service.<\/strong> Hand over a printed copy at intake, or send it with your booking confirmation. The patient should see the amount and the terms before they sign anything.<\/li>\n\n\n\n<li><strong>Fill in the card and cardholder details.<\/strong> Take the cardholder name, billing address, card number, and expiration date. Illegible or missing details invalidate the authorization and cause declines at the register.<\/li>\n\n\n\n<li><strong>State the purpose and the amount in plain figures.<\/strong> Write what the charge covers, such as a $150 consultation deposit or $200 a month for six months of skincare. Vague wording is what loses disputes.<\/li>\n\n\n\n<li><strong>Get the signature and date.<\/strong> The cardholder signs and dates the sheet to confirm the charge. Electronic signatures carry the same legal weight as ink under the <a href=\"https:\/\/www.govinfo.gov\/content\/pkg\/PLAW-106publ229\/html\/PLAW-106publ229.htm\" target=\"_blank\" rel=\"nofollow noopener\">federal ESIGN Act<\/a>.<\/li>\n\n\n\n<li><strong>Store it securely, then dispose of it on a written schedule.<\/strong> PCI DSS sets no retention period. Requirement 3.2.1 asks you to document a retention and disposal policy, and your state law or processor agreement sets the length you keep. Shred paper at the end of that period, and keep digital copies encrypted and access-restricted.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Many practices now capture this with <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">digital intake forms<\/a> instead. The consent is timestamped, the file cannot be misplaced, and nobody has to remember to shred it.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/downloadable_template_article\/credit-card-authorization\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s customizable intake and consent forms take the card authorization at booking, so the signed record files itself against the patient.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-the-three-types-of-authorization\" class=\"wp-block-heading\">The three types of authorization<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Authorization comes in three shapes, and each one needs different wording on the sheet. Many practices end up using all three.<\/p>\n\n\n\n<h3 id=\"h-one-time-payment-authorization\" class=\"wp-block-heading\">One-time payment authorization<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">A one-time authorization covers a single transaction, such as a consultation fee or a treatment deposit. The card is charged once, and the consent is spent. Nothing needs to be said about storage or repeat charges.<\/p>\n\n\n\n<h3 id=\"h-recurring-payment-authorization\" class=\"wp-block-heading\">Recurring payment authorization<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">A recurring authorization lets you charge the same card on a schedule for a treatment course or membership. The wording has to state the amount, the frequency, and the end point. Six monthly charges of $200 for a skincare plan is the level of detail to aim for.<\/p>\n\n\n\n<h3 id=\"h-card-on-file-authorization\" class=\"wp-block-heading\">Card-on-file authorization<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Card-on-file consent lets you keep the card for later use without charging it now. It suits practices that bill a balance after treatment or collect <a href=\"https:\/\/pabau.com\/features\/healthcare-deposit-management\/\">booking deposits<\/a> online.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is the type that needs the most care in writing. Say how long you will keep the card, what you may charge it for, and how the patient can withdraw consent.<\/p>\n\n\n\n<h2 id=\"h-how-credit-card-authorization-works-behind-the-scenes\" class=\"wp-block-heading\">How credit card authorization works behind the scenes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">An authorization does not move money. It reserves it, by placing a temporary hold on the cardholder&#8217;s available balance. Here is the sequence:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Your practice submits the request.<\/strong> The card details and amount go to your payment processor over an encrypted connection.<\/li>\n\n\n\n<li><strong>The processor routes it to the card network.<\/strong> Visa, Mastercard, or American Express passes the request on to the bank that issued the card.<\/li>\n\n\n\n<li><strong>The issuing bank approves or declines.<\/strong> If the funds or credit are available, the bank places a hold on the amount, typically for three to seven days.<\/li>\n\n\n\n<li><strong>You receive an authorization code.<\/strong> Save it with the transaction record. It is your proof that the issuer approved the charge.<\/li>\n\n\n\n<li><strong>The patient sees a pending charge.<\/strong> The hold shows on their statement, but nothing has left their account yet.<\/li>\n\n\n\n<li><strong>Settlement transfers the funds.<\/strong> Once you submit the transaction for settlement, the money reaches your account in one to three business days.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">The practical value of the split is timing. You can authorize at intake and settle after treatment, which protects you if the patient walks out without paying.<\/p>\n\n\n\n<h2 id=\"h-rules-that-apply-in-a-medical-practice\" class=\"wp-block-heading\">Rules that apply in a medical practice<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A medical practice has two rulebooks to satisfy, not one. Payment security rules apply to the card data, and HIPAA applies because the payer is your patient.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>HIPAA and payment data.<\/strong> Card details you collect to pay for a patient&#8217;s care are generally protected health information, or PHI. The <a href=\"https:\/\/www.ecfr.gov\/current\/title-45\/section-160.103\" target=\"_blank\" rel=\"nofollow noopener\">federal definition of PHI<\/a> covers identifiable information about payment for health care, which is what an authorization form documents.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Treat the signed form as part of the patient&#8217;s record. Restrict access to billing staff, log who opens it, and cover it in your vendor agreements. Whether the rule reaches your practice at all comes down to how you bill, and <a href=\"https:\/\/pabau.com\/blog\/do-med-spas-have-to-be-hipaa-compliant\/\">HIPAA for med spas<\/a> walks through that test.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>PCI DSS for practices.<\/strong> Any practice that stores, processes, or transmits card data has to meet the Payment Card Industry Data Security Standard. Card details in a spreadsheet, a shared inbox, or an unlocked drawer all breach it. That exposes you to fraud liability and to fines from your processor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>No-show and cancellation fees.<\/strong> If you charge for missed appointments, the form has to authorize that fee specifically. A blanket line about future charges will not survive a chargeback. Name the fee and the notice period in the same words your <a href=\"https:\/\/pabau.com\/blog\/med-spa-cancellation-policy-guide\/\">cancellation policy<\/a> uses, such as $50 for a cancellation inside 48 hours.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Multi-session treatment plans.<\/strong> Aesthetic and dermatology plans often run to six or twelve sessions. State the number of sessions, the charge dates, and the total cost, so the patient cannot later claim they only agreed to the first one.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that would rather not manage any of this on paper can run the whole workflow through a <a href=\"https:\/\/pabau.com\/blog\/paperless-practice-hipaa-compliant\/\">paperless practice<\/a> setup instead.<\/p>\n\n\n\n<h2 id=\"h-best-practices-for-securing-and-storing-authorization-forms\" class=\"wp-block-heading\">Best practices for securing and storing authorization forms<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Loose paper and shared spreadsheets are a common source of payment data exposure in smaller practices. These six habits remove most of the risk:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Encrypt anything digital.<\/strong> Store signed forms in an encrypted system, and limit access to billing and admin staff. Never email card details, even internally.<\/li>\n\n\n\n<li><strong>Never keep the security code.<\/strong> Destroy it as soon as the charge is authorized. It buys you nothing afterward and breaches PCI DSS the moment it is filed.<\/li>\n\n\n\n<li><strong>Mask the card number on file copies.<\/strong> Keep the last four digits for reference and obscure the rest. That is enough to match a payment to a patient.<\/li>\n\n\n\n<li><strong>Dispose of paper on a written schedule.<\/strong> PCI DSS asks for a documented retention and disposal policy rather than a set number of years. Check your state law and processor terms, then shred on that schedule.<\/li>\n\n\n\n<li><strong>Limit who can look.<\/strong> Billing and admin staff need access to card data. Clinical staff do not, and a role-based permission setting is how you enforce that.<\/li>\n\n\n\n<li><strong>Use tokenization.<\/strong> A processor with tokenization keeps the card in its own vault and hands your system a reference instead. You store the reference, never the number.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Review access quarterly as well. Departing staff and role changes are how old permissions quietly pile up. Most processors also expect you to validate compliance each year with a self-assessment questionnaire.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Collect the authorization before the appointment, not at checkout. Asking for card details after treatment feels transactional, and it is when patients are most likely to refuse or dispute. Take consent at intake, confirm the amount out loud, and checkout becomes a formality.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-which-practices-need-one-on-file\" class=\"wp-block-heading\">Which practices need one on file<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Any practice that charges a patient&#8217;s card away from the terminal needs one on file. That covers:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Medical practices<\/strong> in primary care, internal medicine, urgent care, and specialty settings that take card payments for consultations, treatments, or deposits.<\/li>\n\n\n\n<li><strong>Aesthetic and cosmetic practices<\/strong> offering injectables, laser, or surgical procedures, where deposits and multi-session payment plans are the norm.<\/li>\n\n\n\n<li><strong>Med spas and <a href=\"https:\/\/pabau.com\/industry\/wellness-clinic-software\/\">wellness practices<\/a><\/strong> running memberships, treatment packages, and IV therapy on recurring billing.<\/li>\n\n\n\n<li><strong>Physical therapy and rehabilitation practices<\/strong> that bill a course of treatment upfront or monthly.<\/li>\n\n\n\n<li><strong>Mental health and therapy practices<\/strong> collecting session fees and recurring plan payments between visits.<\/li>\n\n\n\n<li><strong>Dental and orthodontic practices<\/strong>, especially those offering elective and cosmetic work on payment plans.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The common thread is the delay between consent and charge. If you are not standing in front of the patient when the money moves, you need their signature on file.<\/p>\n\n\n\n<h2 id=\"h-benefits-of-getting-authorization-in-writing\" class=\"wp-block-heading\">Benefits of getting authorization in writing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Evidence when a charge is disputed.<\/strong> A signed form is what a card network asks for when a patient claims they never agreed to a payment. Without it, the issuer usually rules for the cardholder.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Fewer chargebacks to fight.<\/strong> Every dispute costs you the amount charged, your processor&#8217;s dispute fee, and the staff hours spent responding. Clear written consent stops most of them at the first step.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Recurring billing that runs itself.<\/strong> One properly worded authorization covers a whole treatment plan. Nobody has to call the patient before each installment, and cash flow becomes predictable. <a href=\"https:\/\/pabau.com\/case-studies\/secret-enhancements\/\">One aesthetic practice<\/a> saved over five hours a week once its deposits ran automatically.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Compliance with card network rules.<\/strong> Visa and Mastercard both require you to obtain and retain the cardholder&#8217;s consent before storing a card or billing it on a schedule. You also have to produce that consent on request.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Fewer awkward conversations.<\/strong> A patient who has read and signed the terms knows what a late cancellation costs. Transparency at intake is cheaper than an argument at the front desk. Treat the fee terms as part of your <a href=\"https:\/\/pabau.com\/blog\/patient-education\/\">patient education<\/a>, alongside aftercare.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-replaces-the-paper-authorization-form\" class=\"wp-block-heading\">How Pabau replaces the paper authorization form<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Paper authorization forms create work at every stage. Someone prints them, chases signatures, files them, redacts them, and eventually shreds them. Pabau, our practice management platform, collects the same consent digitally and keeps it with the patient record.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Consent captured at booking.<\/strong> Patients complete and sign your intake and consent forms online before they arrive. Electronic signatures hold full legal weight under the ESIGN Act, and each one is timestamped against the patient file.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Card details held by the processor.<\/strong> Pabau&#8217;s payments run through Stripe, so the card is stored in the processor&#8217;s vault and Pabau keeps only a reference. Your team never handles a full card number, which takes most of the PCI DSS burden off your practice.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Charges that fire on their own.<\/strong> Once consent is on file, Pabau takes booking deposits, treatment plan installments, and no-show fees automatically. Pabau Pay, our card terminals, handles the in-person payments against the same record.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The result is a shorter path from consent to cash. Nothing waits in a tray to be entered, and every authorization is retrievable in seconds if a payment is ever questioned.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Pabau Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Take card authorization without the paperwork                <\/h3>\n\n                <p class=\"description\">\n                    Patients authorize deposits, plans, and cancellation fees online while they book, and Pabau charges the card automatically when the time comes. The signed consent stays with the patient record, so disputes are answered in seconds.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau clinic management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Download the template, but do not photocopy it as it stands. It gives you the legal furniture, which is a place to set out the terms plus lines for a signature and a date. The checklist above is what turns it into a form you can defend.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you are printing authorization sheets more than a few times a week, the paper itself has become the problem. Storage, redaction, and retrieval all get harder as the stack grows, and each step is somewhere consent can go missing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Digital capture removes that stack entirely and keeps the signed consent attached to the patient. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau takes payment authorization at booking and charges the card on schedule.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Want the authorization captured at intake?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/spa-intake-form-template\/\">Spa intake form template<\/a> collects history, preferences, and consent on one digital sheet.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the policy the late-cancellation fee enforces?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/appointment-cancellation-policy\/\">Appointment cancellation policy<\/a> sets the notice periods and fees your form has to match.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Building recurring revenue streams?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/how-to-build-med-spa-membership-program\/\">How to build a medical spa membership program<\/a> walks through setup, pricing, and payment collection for recurring plans.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Deciding how to structure the practice itself?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/group-practice-vs-private-practice\/\">Group practice vs private practice<\/a> compares the two models on ownership, cost, and admin load.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Handing patients other forms to complete?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/emotional-check-in-worksheet\/\">Emotional check-in worksheet<\/a> is a printable sheet for practices that review progress between visits.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786706209442\"><h3 class=\"schema-faq-question\">What is a credit card authorization form and why do healthcare practices need it?<\/h3> <p class=\"schema-faq-answer\">A credit card authorization form records a patient&#8217;s written consent to charge their card. Practices need it because it proves the charge was agreed, answers chargebacks, and satisfies the card network rules on storing and billing a card.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786706209450\"><h3 class=\"schema-faq-question\">What is inside the downloadable template?<\/h3> <p class=\"schema-faq-answer\">One printable page. It has the form title, an open Authorization details area, a signature line, and a date line. The card number, amount, and payment terms are not pre-printed as separate fields. You write them into the blank area using the checklist in this guide.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786706209447\"><h3 class=\"schema-faq-question\">Can I store a patient&#8217;s full credit card number in their record?<\/h3> <p class=\"schema-faq-answer\">Not in readable form. PCI DSS requires stored card numbers to be rendered unreadable, and most practices should not hold them at all. Use a processor with tokenization, which keeps the card in its own vault and gives your system a reference.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786706209448\"><h3 class=\"schema-faq-question\">What is the difference between authorization and settlement?<\/h3> <p class=\"schema-faq-answer\">Authorization places a temporary hold on the patient&#8217;s card, usually for three to seven days. Settlement moves the money into your account, typically one to three business days after you submit the transaction. Many practices authorize at intake and settle after treatment.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786706209449\"><h3 class=\"schema-faq-question\">Does HIPAA apply to a credit card authorization form?<\/h3> <p class=\"schema-faq-answer\">Generally yes. Card details you collect to pay for a patient&#8217;s care are identifiable information about payment for health care, which HIPAA counts as protected health information. Both HIPAA and PCI DSS apply, so restrict access to billing staff and store the form as part of the record.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>The template is a one-page sheet with a blank authorization area. 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Use a processor with tokenization, which keeps the card in its own vault and gives your system a reference.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/templates\/credit-card-authorization\/#faq-question-1786706209448","position":4,"url":"https:\/\/pabau.com\/es\/templates\/credit-card-authorization\/#faq-question-1786706209448","name":"What is the difference between authorization and settlement?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Authorization places a temporary hold on the patient's card, usually for three to seven days. Settlement moves the money into your account, typically one to three business days after you submit the transaction. Many practices authorize at intake and settle after treatment.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/templates\/credit-card-authorization\/#faq-question-1786706209449","position":5,"url":"https:\/\/pabau.com\/es\/templates\/credit-card-authorization\/#faq-question-1786706209449","name":"Does HIPAA apply to a credit card authorization form?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Generally yes. Card details you collect to pay for a patient's care are identifiable information about payment for health care, which HIPAA counts as protected health information. Both HIPAA and PCI DSS apply, so restrict access to billing staff and store the form as part of the record.","inLanguage":"es"},"inLanguage":"es"}]}},"yoast":{"focus_keyword":"credit card authorization form","seo_title":"Credit card authorization form: free PDF + field checklist","meta_description":"One-page template with a blank authorization area, field checklist, and sample wording to guide completion.","content_score":"90","is_cornerstone":"","related_keyphrases":[{"keyword":"recurring payment authorization","score":61},{"keyword":"credit card authorization hold","score":61},{"keyword":"pci dss compliance","score":61},{"keyword":"hipaa payment data","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/180452","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/users\/84"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/comments?post=180452"}],"version-history":[{"count":5,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/180452\/revisions"}],"predecessor-version":[{"id":184321,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/180452\/revisions\/184321"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media\/180451"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media?parent=180452"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/categories?post=180452"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/tags?post=180452"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}