Cancellation and No Show Policy

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CANCELLATION AND NO SHOW POLICY

We understand that situations arise in which you must cancel your appointment. It is therefore
requested that if you must cancel your appointment you provide more than 24 hours notice. This will
enable another person who is waiting for an appointment to be scheduled in that appointment slot.

With cancellations made less than 24 hours notice, we are unable to offer that slot to other people.
Office appointments which are cancelled with less than 24 hours notification may be subject to a $50.00
cancellation fee. Procedure cancellations require a 5 business day advance notice, without
notification they may be subject to a $150.00 cancellation fee.

Patients who do not show up for their appointment without a call to cancel an office appointment or
procedure appointment will be considered as NO SHOW. Patients who No-Show two (2) or more
times in a 12 month period, may be dismissed from the practice thus they will be denied any future
appointments. Patients may also be subject to a $50.00 fee for office appointment No Show and $150.00 procedure No Show fee.

The Cancellation and No Show fees are the sole responsibility of the patient and must be paid in full
before the patient’s next appointment. We understand that Special unavoidable circumstances may cause you to cancel within 24 hours. Fees in this instance may be waived but only with Provider approval.
Our practice firmly believes that good physician/patient relationship is based upon understanding and
good communication. If you have any questions, please call our office at 720-771-1135.

Please sign that you have read, understand and agree to this Cancellation and No show
Policy.

 
 

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