Cancelled appointments. Principal may be charged as set forth in Appendix 2 if a Member cancels his/her appointment within 24 hours of the scheduled appointment. The PRACTICE understands there are special situations where cancellation within 24 hours is unavoidable and will alwaystake this into consideration. The Member acknowledges it is their responsibility to reschedule cancelled appointments.
Cancelled appointments. I agree that if I cannot make a scheduled appointment that I must provide Xx. Xxxxxx Xxxxx with at least 24 hours notice. I understand that I can contact the office by email xxxxxxxxxxxxx@xxxxx.xxx or by telephone number, 000-000-0000 at anytime, 24 hours a day, to make, change or cancel an appointment. If I fail to do so, I acknowledge and agree that I will be charged, and agree to pay $200.00 for the missed or cancelled appointment. I agree that Xx. Xxxxxx Xxxxx may use the credit card number on file to pay for that appointment. Credit Card Number and Type: Name of Credit Card: Expiry Date: Security Code on back of card: Signed: I, , acknowledge that I have had the opportunity to carefully read this document to ask, and have answered, any questions or concerns I have about it or arising from it. I further acknowledge that I have read and understood the information contained in this document, that it records my consent to participate in the counselling process with XX XXXXXX XXXXX REGISTERED PSYCHOLOGIST#1458 INC., according to the terms outlined above. Client: Provider: Date: Date:
Cancelled appointments. There is no charge if a Patient cancels his or her scheduled appointment or otherwise fails to attend the scheduled appointment. Three unexplained no-shows or cancellations in the span of one year will result in termination of Enrollment.
Cancelled appointments. As a courtesy to our patients, we will remind our patients of their appointments by telephone. Once an appointment has been made, this scheduled time has been reserved for you. We understand that circumstances arise that may prevent you from making your scheduled appointment. However, please note that should you fail to show for your appointment or fail to cancel your scheduled appointment within twenty four (24) hours of the scheduled appointment time, you may be subject to a charge of $250.00. I have reviewed the above terms and agree to be fully responsible for payment of treatment provided by this office. Further, I authorize this office to file claims to my insurance carrier on my behalf. Patient Name
Cancelled appointments. We agree that if we cannot make a scheduled appointment that we must provide Xx. Xxxxxx Xxxxx with at least 24 hours notice. If we fail to do so, we acknowledge and agree that we will be charged, and agree to pay $200.00 for the missed or cancelled appointment. We understand that we can contact the office by email xxxxxxxxxxxxx@xxxxx.xxx or telephone number, 000-000-0000 at anytime, 24 hours a day, to make, change or cancel an appointment. If we fail to do so, we acknowledge and agree that we will be charged, and agree to pay $200.00 for the missed or cancelled appointment. We agree that Xx. Xxxxxx Xxxxx may use the credit card number on file to pay for that appointment. Credit Card Number and Type: Name of Credit Card: Expiry Date: Security Code on back of card: Signed: We, & , acknowledge that we have had the opportunity to carefully read this document to ask, and have answered, any questions or concerns we have about it or arising from it. We further acknowledge that we have read and understood the information contained in this document, that it records my consent to participate in the counselling process with XX XXXXXX XXXXX REGISTERED PSYCHOLOGIST #1458 INC., according to the terms outlined above. Client: Client: Provider: Date: Date: Date:
Cancelled appointments. Patient Member shall be charged $25 if a Patient Member cancels his or her appointment within 24 hours of the scheduled appointment or otherwise fails to attend the scheduled appointment. The fee will be $150 for a new patient appointment that is missed or cancelled within 24 hours of the scheduled appointment time (advance payment is non-refundable). Three unexplained no- shows in the span of one year will result in termination of membership.
Cancelled appointments. All patients will be charged as set forth in the plan description if his/her appointment is canceled within 24 hours of the scheduled appointment. The PRACTICE understands there are special situations where cancellation within 24 hours is unavoidable and will always take this into consideration. The person acknowledges it is their responsibility to reschedule canceled appointments.
Cancelled appointments. Clients are given the same appointment time and days throughout their course of neurofeedback. After your assessment, I will block out those days and times for you for 10 weeks. If you miss an appointment, I cannot fill that slot. All cancellations require 24 hour notice by phone or you will be billed for the full session. You will be responsible to pay for the appointments missed to ensure that you receive the full 20 sessions.
Cancelled appointments. We reserve the right to charge for appointments cancelled or broken without 24-hour notice. We respect your time by reserving a specific appointment time just for you. We do not “double-book” appointments; therefore, your presence is very important.
Cancelled appointments. All cancellations require 24-hour notice by text or voicemail or you will be billed for the full session. I may choose to make exceptions for extenuating circumstances (court, childcare, illness). We may also choose to hold the session through telehealth or video instead of in the office. Insurance and EAP do not cover the late cancellation fee. Every effort to consider the circumstances requiring changes to appointments is made as it is understood by the client that the nature of crisis callout may interfere with clinician availability and could cause last minute rescheduling or cancelling of appointments. Missed Appointments: All missed appointments (no show, no cancellation) will be billed at the agreed upon regular session rate. Insurance and EAP do not cover the cost of missed appointments. If I do not hear from you after a missed appointment and have reason for concern, I may reach out to your identified emergency contact to ensure your well-being.
