Medical Practice Fee Policy
This document is to inform patients of the administrative and cancellation fee policies implemented by our medical practice. These policies ensure that we can continue to provide quality and timely care to all of our patients while respecting the time and resources of both patients and providers.
Medical Paperwork Completion Fee
Patients who request completion of medical paperwork, including but not limited to Family and Medical Leave Act (FMLA) forms, short-term or long-term disability forms, insurance documents, return-to-work clearances, or any other administrative forms, will be subject to a $50 fee. This fee reflects the provider’s time and effort required to accurately and thoroughly complete these documents outside of direct patient care visits.
Same-Day Appointment Cancellation Fee
To ensure that appointment times are respected and remain available for other patients, any appointment canceled on the same day as the scheduled visit will incur a $50 fee. This includes cancellations due to non-emergency reasons or failure to attend the scheduled appointment (no-shows). Patients are encouraged to provide at least 24 hours’ notice when canceling an appointment to avoid this fee.
Payment of Fees
All fees described above are the responsibility of the patient and must be paid in full prior to the release of completed paperwork or prior to scheduling future appointments if outstanding balances remain.
We appreciate your understanding and cooperation in following these policies. By adhering to these guidelines, our practice can continue to deliver efficient, timely, and high-quality care to all patients.
Patient Acknowledgment
I, the undersigned, acknowledge that I have read, understand, and agree to the policies outlined above regarding medical paperwork completion and same-day appointment cancellation fees.