Cancellation Policy

THIS OFFICE REQUIRES 24 HOURS NOTICE PRIOR TO CANCELLATION OF A CONSULTATION

IF AN APPOINTMENT IS NOT CANCELLED 24 HOURS PRIOR THERE IS A $250.00 CHARGE.

As a courtesy, reminder calls are made 2 days before a visit and a day before if the appointment is not yet confirmed.

We understand that there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call to cancel an appointment, you may be preventing another patient from getting much needed medical treatment. Furthermore, we make every effort to minimize wait times in our office by maintaining a tight schedule.

Therefore, if you are unable to keep your scheduled visit, you need to contact us 24 hours prior to cancel or reschedule. If you miss your visit and you do not contact us, you will be charged $250.00 for the missed visit.

THERE ARE NO EXCEPTIONS TO THIS POLICY

Patient Name

Email

Cell Number

Appointment Date

Office Location

Credit Card Authorization Section

Cardholder Name

Cardholder Billing Address

Appointment Date

City

State

Zip Code

Account Number

Amount

VCode

Expiration Date

Patient Signature - Typed signature will be acknowledged as actual signature

Call: 1-888-409-0801

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