Missed Appointments. Policy Agreement Missed appointments represent a loss of an opportunity for someone else to receive services from me. Therefore, I would appreciate knowing as soon as possible if you are going to miss an appointment. Without a full 24 hours notice, I will have to charge you the full fee for any session that is missed. Please note, any late arrival of equal to or greater than 20min from the start of the scheduled appointment time will be considered a “missed visit” and will be charged to you the full fee as well. If you are running late for your appointment, please notify our central intake office as soon as possible (1-855-593- 1157). I have read both pages of this agreement and fully understand each section of this form and agree to participate in counseling services with Xxxxx Xxxxxxx under the provisions, guidelines, and limits delineated above. Client Signature Date
Missed Appointments. We require notice of cancellations 24 hours in advance. This allows us to offer the appointment to another patient. If you fail to keep your appointments without notifying us in advance, a missed appointment fee will apply. These fees are typically $50.
Missed Appointments. An appointment is a reservation of our office and staff for your imaging needs. This time is taken from someone else if we do not have adequate notice of cancellations. Please give us at least 24 hours’ notice if you cannot keep your appointment.
Examples of Missed Appointments in a sentence
Missed appointments without 24 hours notification or a reasonable explanation will be chargeable in full as per the fees set out on the xxxxxxxxxxx.xxx website.
More Definitions of Missed Appointments
Missed Appointments. Unless canceled at least 24 hours in advance, our policy is to charge $25 for missed appointments. We will not file, nor will insurance plans pay for this charge, so please help us serve you better by keeping, or cancelling in advance, scheduled appointments. COLLECTIONS: Failure to pay account balance within 30 days from initial billing may result in interest charges up to maximum legal amount allowed by law and handling fee of $10. Any past due balance not paid will be turned over to a collection agency after 90 days. Any charges and fees resulting from this action, including collecting agency fees, will be added to your account balances and will be your responsibility. In the event that the bill remains unpaid and litigation ensues for collection of sums due, this office shall be entitled to reasonable attorney fees and court costs.
Missed Appointments. Policy Agreement Missed appointments represent a loss of an opportunity for someone else to receive services from me. Therefore, I would appreciate knowing as soon as possible if you are going to miss an appointment. Without a full 24 hours notice, I will have to charge you the full fee for any session that is missed. Please note, any late arrival of equal to or greater than 20min from the start of the scheduled appointment time will be considered a “missed visit” and will be charged to you the full fee as well. If you are running late for your appointment, please notify our central intake office as soon as possible (0-000-000-0000). I have read and agreed to the above. Client Signature Date
Missed Appointments. Our policy is to charge for missed appointments unless a cancellation is received at least 24 hours in advance. The charge is $50 per hour of scheduled time. I acknowledge that I am responsible to pay all charges for treatment administered by 4th Avenue Family Dentistry as outlines above and that if my account is placed with a collection agency for non-payment that I will be responsible for all collection costs, including court costs and associated attorney fees. I have read the policies and agree with the terms outlined above. Responsible Party Signature: Printed Name: Date:
Missed Appointments. When you schedule an appointment, that time is exclusively reserved for you. We request you give us at least 24 hour notice if you need to reschedule an appointment. When the requested time is not given, a fee of $25 per half hour will be charged to your account per client. Payment is due at time of services: We accept cash, checks and most major credit cards for your convenience. When insurance applies, we will collect any deductibles and co-payment at the time of service. We also offer payment options with Care Credit and The Lending Club for more extensive treatment plans.
Missed Appointments. Our policy states that after 2 missed appointments, we require a credit card hold of $150. On the 3rd no show/same day cancellation appointment, we will charge you $150. Please help us serve you better by keeping your scheduled appointment.
Missed Appointments. If you miss or cancel your appointment with less than a 24hr notice, our office reserves the right to bill you $50.00 for each no show or late cancelation. The fee will be your responsibility and will not be billed to your insurance.
Missed Appointments. We request if you are unable to keep a scheduled appointment that you cancel no later than 24 hours prior to your appointment time. The first time you fail to cancel your appointment, as a courtesy, we will contact you to reschedule, the second time you miss an appointment you will be charged a $100 “no-show” fee, and the third time you miss an appointment you will receive a letter discharging you from the practice. Balance: Patient balances will be due in full after 30 days unless prior payment arrangements have been established. Accounts are considered “past-due” after 60 days and subject to collections after 90 days. Collections: Any patient that has been placed in collections must pay any outstanding balances owed along with the collection agency fee to the practice before an appointment will be scheduled or services provided. Form Completion: Most forms are completed within 7-10 business days. The charge for forms to be completed outside of an appointment time is $150 and expected prior to form completion. Payment Plans: Our office will be happy to work with you in order to pay any balance due to our practice. Payment Methods: We accept cash, check, American Express, MasterCard, Visa and Discover. You may also pay your bill online at Refunds: Refunds are issued to the appropriate party. Refunds will not be processed until an account is paid in full. By signing this document, I , have fully read and understand the financial agreement of Thrive Mental Health. I hereby consent to allow Thrive Mental Health to reach me via: (circle all that apply) Home phone ( ) - Cell Phone ( ) - Work Phone ( ) - I will cooperate with the billing agency of Thrive Mental Health to ensure payment for my services. I understand that I will be responsible for any cost(s) associated with the collection of my account if I default on this agreement. I understand that the terms of this financial agreement may be amended at any time without prior notification to me, the patient. If the patient is a minor, I am the parent and/or legal guardian of said patient and agree that I am responsible for all services rendered to the patient herein. Printed name of patient / parent / guardian