Common use of Late Cancel Clause in Contracts

Late Cancel. No Show Policy Effective May 1, 2014 Please take a moment to read this notice. Because of the high demand for psychology appointments in our office, there are special rules that apply to these appointments: • Psychology appointments (initial evaluations / ADHD evaluations / counseling appointments) require at least 48 hours notice if you need to cancel an appointment with one of our psychologists. • If any appointment is canceled with less than 48 hours notice prior to the scheduled appointment time, or if you do not show up for a scheduled appointment, there will be an $85 fee for that missed appointment. I have read the above information and agree to make payment if required. Patient Name Date of Birth Signature of patient, if 18 years or older Date Signature of parent/guardian Date