Payment Options Acceptance Form

Form Template

The Payment Options Acceptance Form mobile app provides a simple way to notify patients about the acceptable payment methods in a dental or medical practice.

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Language: English
Country: United States of America

Use the form to let patients know how they can pay for your services and have them sign off electronically to confirm their agreement with the listed terms.

The form can be customized to include different types of payments, including credit cards, debit cards, money orders, checks, fixed fee payment plans or direct draws from an account. Once completed, the signed form can be saved electronically for your records.

Features
  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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