1. Authorization: I authorize Bloom and Blossom Wellness Center to charge my credit/debit card for balances owed on the day an invoice is created. This includes but is not limited to charges for therapy sessions, missed appointments, late cancellation fees, and other services provided by the practice.

2. Time of Automatic Charge: I understand that the timing of the payment will take place in the evening between 12:00AM and 2:00AM after the invoice is created. Example: Invoice received on 5/8/24 at 10:00AM. It will be automatically charged on 5/9/24 between 12:00AM and 2:00AM.

3. Notification: I understand that I will receive an invoice detailing the charges on the day they are created. All invoices can be found in the client portal. Because insurance takes 2-8 weeks to process claims, you will see charges for copays, coinsurance, and deductible amounts AFTER we receive the insurance payment and notice of your required amount due. You will not receive an invoice on the day of service, as we are required to wait until your insurance processes your claim and reports to us the balance owed by you.

4. Disputed Charges: If I dispute any charge, I agree to contact Bloom and Blossom Wellness Center within 10 business days of the invoice date to resolve the issue.

5. Card Updates: I agree to provide updated card information in the event of a change in my credit/debit card details (e.g., new card number, expiration date).

6. Security: Bloom and Blossom Wellness Center will store my card information securely and will not share it with any third parties, except as required to process payments.

7. Fees: I acknowledge that I am responsible for any fees or charges that may be incurred as a result of insufficient funds or declined transactions.

8. Good Faith Estimate: I understand that I will receive a Good Faith Estimate prior to starting treatment if paying out of pocket for services.

9. Agreement: I understand that if I do not agree to the terms of automatic payment, I will be provided with alternative referrals to providers outside of Bloom and Blossom Wellness Center.