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Card on file and autopay

A card on file lets you charge a client without asking each time — automatically when a visit is completed, for cancellation fees, and for payment plans. Staff save the card from the client's Billing tab (with the client's consent), or the client saves it themselves in the portal. The card number never touches FrontDesk; it lives in Stripe. Autopay at completion is a per-location switch under Settings → Billing → Payment methods and charges only the client's share (their copay if they use insurance). Declines are recorded on the client and reported to staff; the visit still completes.

Updated September 8, 20262 min read

A card on file is a card the client has agreed you may charge later. It powers three things: autopay when a visit is completed, cancellation and no-show fees, and payment plans.

Cards live in Stripe, so connect Stripe for the location first.

Turn autopay on for a location

Settings → Billing → Payment methods → Autopay: switch the location on. The switch is only available once that location's Stripe is taking payments; when on it reads "Charging cards on file when visits are completed." Without it, cards can still be saved and used for fees, plans, and one-off charges.

Save a card as staff

  1. Open the client → Billing tab → Edit on the Billing profile → AutopayAdd card.
  2. Tick the consent line confirming the client agreed to keep the card on file and be charged for visit fees and balances they owe.
  3. Enter the card in the Stripe form and save.

The profile now shows the brand, last four digits, and expiry, with Replace and Remove. The Autopay switch on the profile turns automatic charging on or off for this client alone, and is only available once a card is saved. If Stripe is not connected, Add card says so.

Let the client save it

In the portal, Billing → Card on file → Add a card opens the same Stripe form with a consent checkbox: "I agree that the practice may charge this card for my visit fees and any balance I owe. I can remove it any time." The client sees the saved card, whether visits are charged automatically, and can replace or remove it. See What clients can do in the portal.

What happens at completion

When an appointment is marked completed and its charge is captured:

  1. If the location's autopay switch is on and the client has a card with autopay on, the client's share is charged: the full fee for self-pay clients, the copay for insurance clients (and nothing until a copay is on their profile).
  2. The charge runs off-session and Stripe emails the client a receipt.
  3. The payment is recorded in the client's history, the visit's charge is marked paid, and the balance goes down.

For a group session this runs per attended client.

Declines and card changes

  • Declined: the visit still completes, the charge stays open on the balance, the decline is noted on the client's billing profile and in their portal, and the office gets a Payment failed notification.
  • Expiry and number updates from the card network arrive through Stripe and refresh the saved card automatically; a stale decline note is cleared.
  • Card removed in Stripe turns autopay off for that client.
  • Disputes on autopay charges show as badges on the payment; see Refunds and disputes.

Good to know

  • Autopay charges only the client's share; an insurance client's remaining fee stays open for the claim or the client.
  • A card on file is a per-client consent. Keep the consent line as it is written; it is what the client agreed to.
  • Everything is audited: card saved, removed, autopay on or off, and each charge.

Frequently asked questions

Where is the card number stored?
In Stripe only. The card is entered into a Stripe form embedded in FrontDesk or the portal, and FrontDesk keeps just the brand, last four digits, and expiry. Nobody on your team can see the number, and FrontDesk stays out of PCI scope.
What exactly is charged when a visit completes?
The client's share of the visit fee: the whole fee for a self-pay client, the copay for an insurance client (nothing until a copay is entered on their billing profile). The charge runs off-session, Stripe emails the client a receipt, and the payment shows in their history.
What if the card is declined?
The visit still completes and the charge stays open on the client's balance. The decline is noted on the client's billing profile and in the portal, and the office gets a "Payment failed" notification. Ask the client to replace the card, then collect the balance as usual.
Can the client remove their card?
Yes, from the portal Billing tab at any time. Removing it turns autopay off. Staff can remove or replace it from the Billing tab too. Every save, removal, and autopay change is written to the audit trail.
Does this work for practices connected to athenahealth?
No. Autopay, cancellation fees, and payment plans skip athena-connected practices; billing stays in athena for them.

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