Please understand that our appointment times are scheduled to allow us to take care of each individual patient’s needs during their visit. Since appointments are in high demand, we value advance notice from our patients who are unable to keep their scheduled appointments.
In an effort to decrease unnecessary expenditures and to contain our fees, we have implemented a No Show/Cancellation Policy for all our patients. Please be advised that you are allowed one no-show or same-day cancellation appointment. We will gladly reschedule this appointment without any charge. On your second no-show or same-day cancellation, you will be charged a $95.00 fee that must be paid prior to making additional appointments. Upon your third no-show or same-day cancellation, we reserve the right to terminate the patient-doctor relationship.
Please be assured that we strive to run our office as efficiently as possible in order to provide you the best care and that this policy is in place to help us achieved that goal. We appreciate your understanding and cooperation in this matter.
I have read the above policy and agree to the terms.
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.