If you are unable to keep the time that is exclusively reserved for you, we ask that you kindly provide us with a minimum of 2 business days' notice. Any change to your reserved appointment must be handled during the course of our regular business hours. This courtesy, on your part, will allow us to offer this time to another patient who has had to delay their care. If your reserved appointment time is changed in less than 2 business days, there will be a $50.00 cancellation fee.
I have read, understand and agree to the above Cancellation Policy.
Electronic Signature of Patient (or Guardian). By typing your name in the space below you are providing an "electronic signature" and it indicates you agree to the information contained in this electronic form.