Cancellation Policy & Fee Appeal Form

When an appointment is scheduled, time is reserved especially for you and no one else. Since our appointments are much longer than standard office visits, cancellations are significant interruptions to the clinic. Thus, a minimum of 48 hours’ notice is required for cancellations.

You will be charged a $50 fee for any missed appointments, late cancellations (less than 48 hours’ notice) or late rescheduling (less than 48 hours’ notice). Patients who miss two (2) consecutive appointments without calling to reschedule within the cancellation policy period may be released from care in order to make times available for other patients.

If you have an unresolved fee on your account, we are unable to schedule future appointments until it is resolved.

If you would like to appeal the fee, click the button below. Please note the form must be complete to be considered for a waiver, and filling out the form does not guarantee it will be waived. Thank you in advance for your cooperation.