Billing Info Form
A fixed default form that securely collects a client's credit, debit, or HSA/FSA card during onboarding and stores it on their Client Profile. Add it to an Intake Flow for automatic collection, or request it ad hoc. Only the last four digits of the card are ever visible to the provider, and no charge occurs when the card is entered.
Built by Core Engineering
The problem it solves
Collecting a client's payment method manually, or only after a service is rendered, delays billing and makes it harder to enforce cancellation or no-show policies. The Billing Info Form solves this by securely capturing a valid payment method as part of onboarding, before it's needed.
What's included
- Secure capture of credit, debit, or HSA/FSA card details during onboarding
- Card number format validation with client-facing error correction
- PCI-compliant storage, with only the last four digits visible to the provider
- Client self-service card add/edit from account settings (delete restricted to providers)
- Optional ACH details section when ACH payments are enabled for the account
How it works
A provider adds the Billing Info form to an Intake Flow from Forms > Intake Flow > Select Intake Flow > Add Form to Intake Flow, or requests it ad hoc from a client's profile. When a client completes it, they enter a credit, debit, or HSA/FSA card; the system validates the card number format and prompts the client to correct it if invalid. No charge occurs at the time of entry. Once submitted, the provider can view the last four digits of the card from the Client Profile, and the client can add a new card or edit their existing one from their own account settings, though they cannot delete a card themselves. If ACH payments are enabled for the account, the same form includes a section for entering ACH details.
The Billing Info Form is a fixed default form that securely collects a client's debit, credit, or HSA/FSA card during onboarding, storing it directly in their Client Profile. It's built for practices that want a valid payment method on file before a client's first session, whether for package purchases, cancellation fees, or no-show charges. The form doesn't appear in the standard Forms Library since it's a fixed form, but it can be added to an Intake Flow or requested ad hoc, and clients can also add or update their own payment method later from their account settings. Card details are held by Healthie's PCI-compliant processor; only the last four digits are ever visible to the provider.