Authorize

Credit Card Authorization

Name

I authorize Upsize LLC to charge my credit card $75.00 for a referral to a physician. I understand that this fee is non refundable. Upsize Clinic is a service of Friedlander Pash, PC and serves the Northern California market. For all other markets, Upsize LLC provides marketing services to doctors in other regions, and is not involved in providing penis enlargement or related medical services to those patients. Please note neither Upsize LLC nor Friedlander Pash PC are responsible for any services provided by another medical professional, and each patient should carefully vet any provider before any medical services are provided.