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GORDON WONG MD Update Card on File
Form 7

Card on File

For current and new patients. Visa and Mastercard accepted. Your card details are transmitted to the office over an encrypted connection for entry into the Practice's PCI-DSS-compliant payment processor.

Continuing as Patient. Not me?

Almost done

If you've already spoken with Dr. Wong and have a tentative appointment, please complete this form to finalize and confirm it. If you're just inquiring and haven't yet been in touch with Dr. Wong, feel free to stop here — your inquiry is complete and we'll be in touch.

Secure

Card details are submitted over an encrypted HTTPS connection to the office, which enters them into the Practice's payment processor (Elavon Converge). Your patient record keeps only the last four digits. Visa and Mastercard only.

VISA

HIPAA Compliant · gordonwongmd.com · Visa & Mastercard Only

Card on File Updated

Your card details have been submitted securely. Dr. Wong's office will use this card per the Card-on-File Authorization you signed.

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One Step Before This Form

The following must be completed before the financial forms. Once it is recorded, return to the intake hub to continue.

← Intake Hub