test-payment Open Amount Is this an existing client wanting a single session?* Yes No Client First Name:* Client Last Name:* Client Phone Number (if changed): Email* Session Date* MM slash DD slash YYYY Amount to be Charged:* Am I charging the payment method on file?* Yes No Price Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Total $0.00