The Sasco River Center office policy is to require payment in full at the time of service. Please complete this form to authorize the charge on the date of service. Note that we do not accept the credit card number via this form; you must call in to the office to provide it.
We also want to take this opportunity to remind you of our cancellation / ‘no show’ policy. If you cancel in more than 24 hours before your appointment, you may reschedule at no charge. However, if cancelled less than 24 hours prior to your scheduled appointment time, or are a ‘no show’, we reserve the right to charge you for the session.
Thank you, Sasco River Center
THIS FORM HAS BEEN SUPERSEDED. PLEASE CALL INTAKE TO PROVIDE YOUR CREDIT CARD INFORMATION OVER THE PHONE