Read Microsoft Word - 4.0 Cancellation Policy Letter.doc text version

CANCELLATION AND NO-SHOW APPOINTMENT POLICY

We at Comprehensive Psychiatric Resources understand that sometimes you need to cancel or reschedule your appointment and there are emergencies. If you are unable to keep your appointment, please notify us as soon as possible. A `Cancelled Appointment' is defined as any cancellation less than 24 hours. A `No-Show appointment' is defined as an appointment where there was no attendance and notice was not given. Due to the busy schedule maintained by the Comprehensive Psychiatric Resources clinician's, it has become imperative that we institute a cancellation policy. Please review the following cancellation policy:

1) Please cancel your appointment with at least 24 hours notice: There is a waiting list to see the clinician's at CPR and whenever possible, we like to fill cancelled spaces to shorten the waiting period for our patients. 2) Cancelling or No-Show appointments will result in a fee for the full amount of the missed or cancelled appointment.

I understand Comprehensive Psychiatric Resources appointment cancellation and no-show policy and understand my responsibility to plan appointments accordingly and notify CPR appropriately if I have difficulty fulfilling my scheduled appointments.

_________________________________________

Patient or Guardian's Name

_____________________

Date

_________________________________________

Witness

_____________________

Date

20 Hope Ave, Suite 107 ~ Waltham, MA 02453 ~ T: (781) 647-6765 ~ Fax: (781) 899-4905

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