The Children's Clinic of Conway & Greenbrier sees patients by scheduled appointment and for emergencies. We try to see all those who need appointments within an appropriate amount of time allotted for each visit.

We reserve time for each patient, and if the patient does not come to the appointment the result is lost revenue to the clinic and a missed opportunity for someone else to be given the appointment time.

To address the problem of frequent missed appointments (often multiple missed appointments within a family) and provide appointments for as many patients as possible, we have instituted a financial penalty for people who repeatedly miss appointments.

Arriving 20 minutes late to an appointment is the same as missing an appointment, and in most cases, you will be asked to reschedule the appointment and pay the fee.

Canceling an appointment less than an hour before the appointment is the same as a missed appointment. Call the day before or early in the day if you need to cancel or reschedule an appointment.

Missed appointments within a family are tracked together. If two children each miss one appointment, it counts as two missed appointments for your family.

I understand that for certain missed appointments (see below) I will be charged a $35 or $50 fee, PAYABLE BEFORE FURTHER APPOINTMENTS ARE SCHEDULED, and that if I repeatedly miss appointments, I will be asked to find another doctor for my children. I understand that Medicaid, ARKids, and private insurance do not cover these costs and I will be expected to pay the clinic directly.

• New patient missed appointment: $50
• Second missed appointment: $35
• Third missed appointment: $35 and you may be asked to see a new provider at a different clinic

*The signature below covers the above authorizations and consents for all patients listed below.