PAYMENT AUTHORIZATION
 

I hereby authorize Wellness Family Health NP Practice DBA Health Wave Connect to charge my credit card or initiate a debit transfer for the amount agreed to base on the service selected. 

Once your information has been reviewed by our provider, an invoice will be sent to your account inside the patient portal and at that time you will enter your payment information. No orders will be placed until the invoice is paid. 

 

Refund Policy:

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There are no refunds for services rendered. If your treatment plan involves medications/vitamins shipped directly to you, once the order has been placed with the pharmacy or vendor, no refund requests may be made due to the nature of the service. By law, medications cannot be returned. 

 

**Please note your payment information is through a secure portal and only the last 4 digits will be visible to the practice.