No-Show and Cancellation Agreement Sample Clauses

No-Show and Cancellation Agreement. In an effort to provide excellent client service to all of our clients, and to provide the best possible therapeutic environment, it is our policy to require a fee for no-show appointments and cancellations made less than 24 hours in advance of the scheduled appointment. The fee of $75.00 will be implemented in your account. I,(named below) understand and agree that if I do not show up for my scheduled appointment or if I cancel my scheduled appointment with less than 24 hours’ notice, I will be charged a fee of $75.00 First Name Last Name Patient/Guardian Signature Date Patient's Name

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Related Clauses

Related to No-Show and Cancellation Agreement