Brookline 617-860-6430 Fort Point 617-608-3695 Acton 617-860-6426 info@postpt.com

Credit Card Information

By providing your credit card information below, you agree to all of POST Physical Therapy’s Credit Card on File Policy and are aware that your valid credit/debit card number will be securely on-file in your account.

You understand that POST Physical Therapy will automatically charge your credit card for all co-payments and cancellation fees. Missed or cancelled appointments without 24-hour notice will be charged a $50 fee at the time of the appointment. POST will not automatically process any other balances that aren’t co-payments or cancellation fees.

You can ask that the card kept on file is used to pay any deductible, coinsurance or other statement balances you may receive going forward or for any current balances you may have now. POST will attempt to contact you three times regarding any past due balances before applying that balance to the credit card on file.

If the credit card that you give today changes, expires, or is denied for any reason, then please immediately contact POST Physical Therapy with a new, valid credit card.

Thank you,

POST

  • Please note that we do not accept AMEX.

  • Please type in the name of the patient or the guardian, if patient is under 18 years of age, to sign the document.