CANCELLATIONS AND MISSED APPOINTMENTS. Your appointment time has been reserved exclusively for you. If you are late, we will end on time and not run over into the next person's session. If you are unable to keep your appointment, please notify the office at least 24 hours in advance so that time can be used to schedule other clients. Each clinician has voicemail available for your convenience after hours. In the event you miss an appointment or cancel with less than 24 hours, you will be assessed a fee of $50.00. Missed appointment fees are not billed to insurance providers or employee assistance programs. These charges are the sole responsibility of the client. If you no-show for two sessions in a row and do not respond to our attempts to reschedule, we will assume that you have dropped out of counseling and will make the space available to another individual. FEES & INSURANCE POLICIES Life Strategy Consultants, LLC is in-network and accepts payment from a variety of insurance providers and Employee Assistance Programs. In the event that Life Strategy Consultants, LLC does not accept your insurance, you may be able to use out-of-network benefits with your insurance provider. All clients have the option to select the “Self-Pay Rate” and pay for services without involving an insurance provider. Payment for each counseling session is expected at the time of service. For in-network insurance payments, the copay amount is due. For out-of-network insurance and “Self-Pay,” payment-in-full is due. Failure to pay two consecutive appointments at the time of service may result in a pause in treatment until payment is received. Life Strategy Consultants, LLC accepts credit/debit cards, checks, and cash. If a check is returned for insufficient funds, a charge of $35 will be added to your balance due.
CANCELLATIONS AND MISSED APPOINTMENTS. We never purposely double-book our therapy schedules. Instead, we reserve a specific time for you to receive services. Because this time has been reserved specifically for you, we expect you to provide at least 48 hours’ notice if you need to cancel or reschedule the session. Sessions without 48 hours’ notice will be charged a $100 no-show fee. If you miss 3 sessions without giving us 48 hours’ notice, we will assume that you no longer wish to receive any services. Your regular standing appointment may be given to someone else at that time. As explained at the time you scheduled your first appointment, a credit card on file was required in order to reserve your first appointment. It is our policy to charge a $100 no-show fee if the first session is missed. If the first appointment was attended as planned, regular insurance or self-pay fees apply. (The reservation fee is not charged if you show up for the first session.)
CANCELLATIONS AND MISSED APPOINTMENTS. Insurance companies and Medicaid do not pay for missed or cancelled appointments. Cancellations require at least 24- hour notice by phone. If we are closed or otherwise unavailable, leave a confidential voicemail to cancel. If an appointment is cancelled or missed without the appropriate notice, you will be charged $25.00.
CANCELLATIONS AND MISSED APPOINTMENTS. If you do not show up for your scheduled appointment and you have not provided 48-‐‑hour notice of the cancellation you will be required to pay the full cost of the session. An exception to this would be an unanticipated circumstance that could reasonably be called an emergency or an illness. I have read, understand and agree to this Financial Agreement and Terms. Client Signature Date Signature of Responsible Party Date Therapist’s Initials 🞏 Copy Accepted by client 🞏 Copy kept by therapist
CANCELLATIONS AND MISSED APPOINTMENTS. You will be billed $75.00 for a session that you cancel (or Do not show for) with less than 24 hours notice. You may leave messages 24 hours per
CANCELLATIONS AND MISSED APPOINTMENTS. A credit card number will be taken at the onset of your counseling. Appointments must be canceled at least 48 hours in advance to avoid incurring a charge. The 48 hours are within business hours and do not include weekends or holidays. Late cancellations or not showing up on the day of a scheduled appointment will be charged at the regular hourly fee to your credit card. If you have a true emergency, your credit card will not be charged.
CANCELLATIONS AND MISSED APPOINTMENTS. Cancellations must be made 24 hours in advance; otherwise, you will be held responsible for the session fee. Insurance will not pay for missed appointments.
CANCELLATIONS AND MISSED APPOINTMENTS. Xx. Xxxxx has a 48 hrs cancellation policy. This policy allows for time to be reserved for your child. Because emergencies occur you will be allowed one late cancellation without being charged a late fee. Please be aware that insurance will not reimburse you for charges due to late cancellations. (initial) ____________
CANCELLATIONS AND MISSED APPOINTMENTS. A minimum of 72 hours’ notice must be given for all surgical appointments, 48 hours for non-surgical appointments. A fee will be charged to your account for all missed appointments. Charges for missed appoints will be identified as such and are not covered by insurance.
CANCELLATIONS AND MISSED APPOINTMENTS. You agree to arrive on time for your appointments. If you arrive late, I will see you for the time remaining in the appointment but missed time cannot be made up. If you’re 10 or more minutes late for a 20-minute visit, I cannot see you that day and will charge a missed appointment fee for the visit. When possible, if running late, you agree to notify me by text, voice message or email. You agree to provide 48 hours’ notice of a cancellation or a reschedule request. If you provide less notice, you agree to pay the full appointment fee. I reserve the right to waive or modify the cancellation policy in exceptional circumstances. New patients who arrive 15 or more minutes late to the first appointment cannot be seen, will forfeit the deposit and be offered rescheduling. Initials PRESCRIPTION POLICIES To provide safe and error-free care, I provide medication refills only during follow-up appointments. I don’t authorize refills in response to requests from your pharmacy, so please don’t initiate refill requests with them. You understand that I will prescribe enough medication to last until the next recommended visit. You agree to track your supply of medication and remaining refills, and to request prescription refills only during my appointments. You’re responsible for making a timely appointment request that ensures an adequate supply of medication. If that responsibility isn’t met, and I deem a refill to be medically necessary, you agree to pay the between-visit refill fee. Prescriptions for controlled substances such as sleep, anti-anxiety or ADD medication will only be provided during appointments. You agree that while being prescribed a controlled substance, you’ll need to be seen monthly for the first several months, and then at least every 3 months, without exception. I subscribe to the Washington State Prescription Drug Monitoring Program to track patients’ use of controlled substances. Misrepresentation about or misuse of controlled substances may be cause for patient discharge. You agree to my policies regarding prescriptions and controlled substances. Initials
