PPCC DRUG & ALCOHOL ASSESSMENT

PPCC DRUG & ALCOHOL ASSESSMENT

ASI APPOINTMENT FOR P.O. OR COURT
POLICY FOR A MISSED APPOINTMENT & RESCHEDULING FEE

Please be advised that missing two appointments will result in the forfeiture of your assessment fee. There are no exceptions to this policy. Our therapists have very busy schedules, so kindly ensure you are available when scheduling your assessment.

EXPECT AN ADDITIONAL EMAIL OR CONTACT VIA PHONE FROM THE THERAPIST.

Please be available at the appointment time. There will be an additional $65. fee to reschedule for a no call/no show. Please contact us for any changes in your schedule.

Thank you,
Mr. Edgar
I AGREE TO PPCC POLICY FOR MISSED APPOINTMENTS & RESCHEDULE FEE
I agree to the $45 processing fee being non-refundable.
Name*

First NameLast Name
YOUR Email*
example@example.com
YOUR Phone Number*
Please enter a valid phone number.
P.O. AGENT Name*

First NameLast Name
P.O /AGENT Email*
example@example.com
P.O. /AGENT Phone Number*
Please enter a valid phone number.
GIVE 3 DATES AND TIMES YOU ARE AVAILABLE

Appointments need to be scheduled at least 3 days after you plan to make your payment. You will then receive an email informing you of your appointment date and time. Example: If today is Monday pick dates starting on Wednesday. Do not put the same day unless you will be paying the $125 fee for same day appointments. Call the office for same day appointment.
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option

MUST PAY FEE 160.00*

USDASI FOR COURT/P.O.

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Should be Empty:

PPCC DRUG & ALCOHOL ASSESSMENT

GIVE 3 DATES AND TIMES YOU ARE AVAILABLE

Payment Methods