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    I hereby authorize Gold Speech, Inc. to charge the indicated credit card. I am aware of the company policy requiring cancellation by 7:00 a.m., if not sooner, the day of the scheduled session, to avoid the session charge. I am aware that I cannot receive reimbursement from my medical insurance for late cancellation fees of missed sessions. I agree that this is either a recurring or one-time charge that will be made, and I will not dispute it in the future. To terminate the recurring billing process, I must cancel in writing, giving 14 days notice prior to the last therapy session.