|Payment on Account
If you are providing ongoing funding for another's regular services, please complete a Credit Card Authorization Form and
fax it back to us at 972-335-2434, along with a clear copy of the front and back of the card to be used.
If the credit card provided is declined, the account will be subject to an additional fee of $35.00
There will be no refunds for missed or late-cancelled appointments and all of our Office Policies apply to interactions in this format.
Continuing with this payment process indicates your understanding of and agreement to abide by these terms.
The payer may also stop by the office during office hours to pay on an account or prepay a visit. At that time the payer
will also be requested to deliver the completed Credit Card Authorization Form or complete one while in the office. A
copy of the card, front and back, will be taken at that time.
|Stonebriar Psychiatric Services, P.A.
3550 Parkwood Blvd. Suite 705
Frisco, TX 75034