Payment Authorisation

please complete in full

  • DETAILS
  • CARD INFO
  • TERMS

DETAILS

YOUR NAME

YOUR ADDRESS

YOUR POSTCODE

please enter the long card number without any spaces

CARD TYPE

CARD NUMBER

Expiry Date (MM/YY)

card security number

AUTH.

Is this your card?

If 'no', who does this card belong to?

What is the address of the cardholder? (if not you)

Do we have the permission of the cardholder to charge to this card?

TERMS

By providing these details you agree to our standard terms and conditions.


Your financial statement will be visible on your personal login page at all times.


You agree to ensure there are sufficient funds to pay the charges.


Any failed payments will accrue a £30 administrative charge.


Payment details are held and stored securely by our bank. Once entered, we can only see the last 4 digits of your payment card.

Your card details are held on file for payment of consultations, treatments and purchases. We are unable to accept any bookings without an active payment card on your account.

CONFIRMATION