Credit Card Authorization Form

To ensure a seamless and personalized experience, pre-payment is required for all services involving custom laboratory work. Please complete and return this authorization form to approve the charge for the amount indicated in your personalized statement, as outlined in your email.

Your card will also be used to reserve your appointment. Should you need to cancel or reschedule, we kindly request a minimum of 48 hours’ notice. Cancellations made after this period—or missed appointments—will be subject to the agreed policy and charged accordingly.

For your security, a nominal $1 authorization will be processed and immediately refunded upon receipt of this form. Once verification is complete, your appointment will be confirmed.

We sincerely appreciate your trust and cooperation, and we look forward to welcoming you to your appointment.