Cancellation Policy

THIS OFFICE REQUIRES 24 HOURS NOTICE PRIOR TO A CANCELLATION

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

    Office Location

    Credit Card Authorization Section

    Cardholder Name

    Cardholder Billing Address

    City

    State

    Zip Code

    Account Number

    Please charge my account 250.00

    VCode

    Expiration Date

    Patient Signature - Typed signature will be acknowledged as actual signature and acknowledge amount of $250.00

    Call: 1-888-409-0801

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