Every “no show” delays the opportunity for evaluation of other individuals. We ask you help us by giving 24 hours advanced notice of cancellation or rescheduling.
I understand that an appointment time has been made for me and if I do not keep my scheduled appointment, or if I do not give 24 hour advance notice, I will be charged a $45.00 no show fee. I also understand that if the fee is not paid it will be sent through the normal collection process.
If it becomes necessary for the account to be referred to an attorney for collection or suit, the undersigned shall pay reasonable attorney’s fees and collection expenses. Further, I understand that coinsurance, unsatisfied deductible amounts, etc. are requested at time of service unless other financial arrangements have been made in advance.
Multiple cancellations and non-payment of no show fee will result in you being referred to a different medical practice.
I understand that New Patient Forms 1-4 must be fully completed, signed and returned to Hollowbrook Foot Specialist, PC before my appointment.