Cancellation Policy Form Cancellation Policy FormName *Email *Address Street AddressApt, Suite, Bldg. 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YesNoAgreement 24 HOUR CANCELLATION/MISSED APPOINTMENT POLICIES REASON FOR THE CANCELLATION POLICY: Notifying me of your intention to cancel or reschedule more than 24 hours in advance gives me the opportunity to schedule someone else for that time slot. This is important because my schedule is limited and I often work from a waiting list of patients needing appointments. Sometimes a crisis situation arises for another patient and they may need that time slot as well. I prepare for each appointment through any necessary research, records review, and planning and rather than spending time preparing for a canceled appointment, I prefer to devote this time to other patients. I will happily prepare for your next scheduled appointment at that time. IF YOU CANCEL YOUR APPOINTMENT WITH LESS THAN 24 HOURS NOTICE, YOU WILL BE CHARGED THE REGULAR TREATMENT FEE (INCLUDING ANY HOUSECALL FEES) FOR THE APPOINTMENT ARRIVING LATE TO OFFICE APPOINTMENT WITH NOTIFICATION: If you notify me, even a few minutes ahead of time at the phone number above, your appointment time will be held for you and you will have the time that remains in your pet's treatment. As long as you arrive within your scheduled treatment time, you will pay the usual treatment fee. ARRIVING LATE TO OFFICE APPOINTMENT WITHOUT NOTIFICATION: I will wait for you for 10 minutes into your appointment time. After 10 minutes, it will be assumed that you have missed your appointment. I may move on to the next scheduled appointment or leave the office. You will be charged the full treatment fee for this missed appointment. IF YOU MISS YOUR OFFICE APPOINTMENT DUE TO LATE ARRIVAL, YOU WILL BE CHARGED IN FULL FOR THE SCHEDULED TREATMENT (Missed appointment/late arrival policies do not apply to home visit appointments) IF YOU SIMPLY DO NOT SHOW UP, OR ARE NOT HOME AT THE TIME OF THE SCHEDULED APPOINTMENT, YOU WILL BE CHARGED IN FULL FOR THE SCHEDULED TREATMENT (INCLUDING ANY HOUSECALL FEES) NOTIFICATION PHONE NUMBER FOR CANCELLATION OR LATE ARRIVAL 773-317-1937 This is my cell phone number. Please make all cancellations notifications at this number by leaving a detailed message including your name and scheduled appointment day and time. I will call you back to reschedule your canceled appointment as soon as I can. Do not cancel via email, text message, or by any other means as I may not receive these in a timely manner and this may be considered a late cancellation. Contact me at the same number with late arrival notifications. Please store this number where it will be convenient for you It is possible that your pet's medical care will be suspended until any applicable cancellation or missed appointment fees are paid. Such policies are standard in the medical field and will be strictly enforced. On occasion, there will be understandable reasons for missing appointments, but exceptions to this policy will be rare. If you have questions about the cancellation or missed appointment policies, you should discuss them at the start of your visit.E-Signature *Thank you for your cooperation. Please sign below to indicate that you have read, understand, and agree to abide by both the cancellation and missed appointment policies. By checking "yes" you affix your e-signature to the above statement.YesNo VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
