Attendance Cancellation Policy

Attendance Cancellation Policy

Please review the cancellation policy below and initial to acknowledge your understanding.
Cornerstone is committed to the best treatment possible for your child, Due to an increasing problem with "No Shows"for scheduled appointments, even with a text confirmation the Friday before, I regretfully must Institute a "No Show Policy"....

"No Shows" drive up the cost of patient appointments for everyone. "No Shows" also prevent us from taking a patient who could have been seen that day but were not because someone was scheduled for that time siot.
For this reason, a $50.00 fee will be charged to you for the fallure to show for a scheduled appointment or for legitimate cancellations not made within 24 hours of that appointment. This charge is NOT covered by your
insurance, If you are unable to keep your appointment, please give 24 hours' notice to your therapist to avold this charge.

Also, the "reminding" text Is ONLY a courtesy...not receiving that text does not relleve you of your responsibility to arrive for your appointment or cancel appropriately.
Childhood Disease:
Please note if your child contracts lice, ringworm, pink eye, strep throat, chickenpox or any other typical childhood communicable disease, you need to contact our office immediately. The child will be placed on hold until the contagious perlod Is over, and your doctor gives Cornerstone authorization to resume
treatment.
Initials*
Holiday and School Vacations:
Cornerstone Therapy Services does not follow the school calendar. We are open 12 months a year and closed only for the following holidays: New Year's Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day, and
Christmas Day. Unless otherwise explicitly stated, we are open our regular hours on the days immediately before and after these holidays. If your child has a special school event or vacatlon, please Inform your therapist 30 days in advance in order to rearrange the schedule.
Initials*
Attendance:
Therapy willnot be effective unless it is consistent and regular. Therefore, regular attendance to all appointments are Important. If two or more appointments within a four-week period are missed due to reasons other than illness, and not rescheduled, we wll! not be able to hold the appointment time and It will
be given to another person. In that case, we will place you on our waiting list for therapy. If the regular appointment time is difficult to maintain, piease discuss the possibllity of a different day or time with your therapist. We cannot guarantee an appointment be held for an extended vacation greater than 30 days.
Initials*
MY SIGNATURE BELOW INDICATES THAT I HAVE READ THE ABOVE POLICY AND UNDERSTAND AND AССЕРТ THE TERMS AND CONDITIONS.
Please Print Name of Patient
Date

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Signature
Therapist name: First Name Last Name Therapist Phone: Area Code Phone Number
Therapist Name: First Name Last Name Therapist Phone: Area Code Phone Number
Therapist Name: First Name Last Name Therapist Phone: Area Code Phone Number
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