50% of Assessment Package cost due at the time of scheduling.
Cancellation of appointments will not result in immediate refund of payment.
We require full payment prior to services being rendered. You can expect to pay the full cost of your service as a hold on your appointment time due 24 hours before appointment. The cost can be charged to a card on file or payment can be taken by calling (916) 836-0036 or text to (916) 505-7375.Should you forget to pay prior to your appointment, you are authorizing MotlMD to charge your card on file for your appointment upon arrival for service.
For all of our assessments, 50% of total cost is due at the time of scheduling.
The remaining balance is due 5 business days prior to appointment. Email reminders will be sent out attached to your invoice.If your assessment is not paid in full or payment arrangements have not been made with our office, your next appointment will be canceled with notice. You will not be eligible to schedule an appointment until payment has been received or arrangements have been made.
Card information on file
MotlMD requires that all patients provide a form of payment to hold on file. Upon scheduling, you will be asked for your card information, but not charged unless otherwise specified. This policy allows for smoother transactions and billing and will ensure that MotlMD can collect for services rendered in a timely manner from all patients.
I, the undersigned cardholder, authorize the merchant known as MotlMD to charge my credit card for purchases related to goods, services, and late cancellation charges. I agree that my information may be saved by the merchant for future payments and understand that this can be revoked at any time with request.
Cardholder’s Signature: __________________________________________________________ Date: __________________