Companion Animal Chiropractic, LLC Cancellation Policy Acknowledgement
Please review and acknowledge our cancellation and missed appointment policy for Companion Animal Chiropractic. Your acknowledgement is required to continue care.
Owner Full Name
*
First Name
Last Name
Pet Name(s)
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
-
Month
-
Day
Year
Date
Cancellation/Missed Appointment Policy
Missed appointments (no show or arrival more than 10 minutes late) require rescheduling and may incur a $40 fee. Late cancellation (less than 24 hours’ notice) also incurs a $40 fee per appointment. Repeated violations may require a credit card on file and could result in dismissal from care.
I have read, understand, and agree to the Cancellation Policy above.
*
I have read, understand, and agree to the Cancellation Policy above.
Owner Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Acknowledge Policy
Acknowledge Policy
Should be Empty: