PLEASE USE THIS FORM IF THE SESSION WAS CANCELLED OR RESCHEDULED WITH LESS THAN 24H ADVANCE NOTICE
Dear Clinicians, we appreciate your cooperation in adhering to our 24-hour cancellation policy. Late cancellations impact our ability to offer timely care to other patients. Please complete the form below if a patient cancels their appointment with less than 24 hours' notice, or the session could not be rendered.
This form becomes part of the client's billing log, and will be disclosed to third parties if required by law. .
Please allocate 3-7 minutes to complete the form.
Once you submit this form, it is forwarded to our accounting office. It is processed in 1 to 3 business days. Please inform the client of the required time-frame.