Credit Card Authorization

Please complete all fields. You may cancel this authorization, but further appointments will not be scheduled without a credit card on file. This authorization will remain in effect until cancelled.

Credit Type:(Required)
Name(Required)
Clear Signature
Please Initial

Credit Card Authorization Form

Formerly Clearwater

  • Phone: 727-477-3636
  • Email: Info@clearwateraesthetics.com
  • Office Address: 818 Chestnut St, Clearwater, FL 33756

Port Richey

  • Phone:+1 (727) 477 3380
  • Email: appointment@epicaesthetix.com
  • Office Address: Port Richey,6652 Ridge Rd, Port Richey, Florida 34668

Spring Hill

  • Phone:+1 (352) 352 8866
  • Email: appointment@epicaesthetix.com
  • Office Address: Spring Hill, 7351 Spring Hill Drive Unit 7, Spring Hill, Florida 34606

Brooksville

  • Phone:+1 (352) 352 9800
  • Email: appointment@epicaesthetix.com
  • Office Address: Brooksville, 20126 Cortez Boulevard, Brooksville, Florida 34601

Weeki Wache

  • Phone:+1 (352) 352 9045
  • Email: appointment@epicaesthetix.com
  • Office Address: Weeki Wache, 6254 Commercial Way, Spring Hill, Florida 34613

St. Petersburg

  • Phone:+1 (727) 477 3383
  • Email: appointment@epicaesthetix.com
  • Office Address: St. Petersburg, 10410 Roosevelt Blvd N, St. Petersburg, Florida 33716

COPYRIGHT © 2025 EPIC AESTHETIX. ALL RIGHTS RESERVED

This will close in 0 seconds

This will close in 0 seconds

This will close in 0 seconds

This will close in 0 seconds

This will close in 0 seconds

This will close in 0 seconds

Hormone Consultation Therapy (St. Petersburg)

This will close in 0 seconds

Weight Loss (Semetaglutide | Wegovy | Monjaro) (St. Petersburg)

This will close in 0 seconds

IV Therapy (Myers Cocktail | Immunity Boost) (St. Petersburg)

This will close in 0 seconds

CO₂ DEKA TETRA | CO₂ Laser CoolPeel™ (St. Petersburg)

This will close in 0 seconds

Book Appointment at St. Petersburg

This will close in 0 seconds

Book Appointment at Brooksville

This will close in 0 seconds

Derma Filler at Brooksville

This will close in 0 seconds

Botox at Brooksville

This will close in 0 seconds

Weight Loss (Injectable GLP-1 at Brooksville)

This will close in 0 seconds

HRT Testosterone at Brooksville

This will close in 0 seconds

Book Appointment at Port Richey

This will close in 0 seconds

HRT Testosterone at Port Richey

This will close in 0 seconds

Weight Loss (Injectable GLP-1 at Port Richey)

This will close in 0 seconds

IV Therapy (Myers Cocktail | Immunity Boost) (Port Richey)

This will close in 0 seconds

IV Therapy (Myers Cocktail | Immunity Boost) (Port Richey)

This will close in 0 seconds

Book Appointment at Spring Hill

This will close in 0 seconds

HRT at Spring Hill

This will close in 0 seconds

Weight-Loss at Spring Hill

This will close in 0 seconds

Botox at Spring Hill

This will close in 0 seconds

Filler at Spring Hill

This will close in 0 seconds

Book Appointment at Weeki Wachee

This will close in 0 seconds

Filler at Weeki Wachee

This will close in 0 seconds

Botox at Weeki Wachee

This will close in 0 seconds

Weight-Loss at Weeki Wachee

This will close in 0 seconds

HRT at Weeki Wachee

This will close in 0 seconds

Copy - Book Appointment at Brooksville

This will close in 0 seconds