IV Hydration, Primary Care, Men's Health, HGH, Testosterone

I understand and acknowledge that NPS WITH IVS HYDRATION AND WELLNESS LLC, hereafter known as "the practice," require a credit or debit card on file for all services. My card will NOT be charged without your permission, EXCEPT in the following cases: 

1. Late cancellations or appointment no-shows  

2. Your bill is more than 60 days past due, without alternative payment arrangements in place  

I understand that my information will be saved for future transactions.  I also understand that payment is due at the time of scheduling, NOT at the time of the visit.  I understand that each time I schedule an appointment, my card will be charged the $75 appointment charge. The remainder of  the service will be added at the time of the appointment.  

Should I enter a subscription program, my card will be charged per the agreed upon program price.  

I hereby give authorization for any card on my account to be charged for any current, recurrent or past due balances on my  account on an on-going basis. This permission will continue until cancelled in writing by me. 

I understand that my provided card on file will be the preferred method or payment  

I hereby authorize the practice to charge any outstanding balance to the card on file and understand that my card will be charged at any time payment is due.  

By signing below, I, being the authorized cardholder, agree to the terms set forth in this agreement and agree to pay and  specifically authorize the practice to charge my credit card for the services provided. I further agree that I will provide a new valid  card upon request to be charged for any payments in the event my card becomes invalid.