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Cancellation Agreement
We understand there are times when you must miss an appointment due to emergencies or obligations to work and family. However, when you do not call to cancel an appointment, you may be preventing another patient from getting a much needed treatment. Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for an appointment, due to a seemingly "full" appointment book.
If an appointment is not cancelled at least 24 hours in advance, you personally (not your insurance company), will be charged a $25.00 cancellation fee. If you should fail to show up for an appointment or call, you will be charged a $50.00 no-show fee. ($100.00 for a missed EMG/Nerve test.)
We appreciate your understanding and cooperation.
--Integrated Neurology Services
I have read and accept the above agreement and wish to continue to download the new patient forms:
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