It is your responsibility as the patient to attend all scheduled appointments. If, for some reason,
you are unable to make your appointment, it is YOUR RESPONSIBILITY TO CANCEL the
appointment with a member of our staff, 24 (twenty-four) hours prior to the scheduled appointment
time. For New Patient Appointments, we require a 3-day notice to cancel or reschedule. Messages
are acceptable and can be left during normal business hours. If you do not provide at least 24
hours’ notice (3 days for New Patient Appointments), you will be charged a No-Show fee of $35 for
each appointment missed. In addition, if you are more than 15 minutes late to your appointment,
this will be considered a No-Show and you will be charged the No-Show fee. Subsequent missed
appointments will result in additional $35 charges and possible dismissal from the practice.
Patients who have arrived on time will be seen ahead of those who arrive late to their
appointment. If you arrive late, we reserve the right to abbreviate or reschedule your visit upon
your arrival. This helps us reduce wait times for patients. Patients who have 2 No-shows with a
provider will be discharged from the practice. Patient will be provided 30 days under provider care
in order to locate a new provider. Upon the second No-show the practice will serve patient with a
No-show letter of termination and the patient will not be allowed to be seen with the practice for at
least one year from date of termination. No-Show fees will be added to your patient due statement.
These fees must be paid at your next scheduled appointment. Insurance will not be billed for these
charges and they are the sole responsibility of the patient. The fee(s) may only be waived by the
Practice Manager and are decided on a case by case basis. Please indicate your agreement to
the terms of this policy by signing below. This acknowledges that you have read, understood, and
agreed to our policy.