Confirmation, No Show, Late and Cancellation Policy

Description:

  • “Confirmation” : the patient must confirm with the office 48 hours prior to appointment
  • “No Show” : any patient who fails to arrive for a scheduled appointment.
  • “Same Day Cancellation” : any patient who cancels an appointment less than 24 hours before their scheduled appointment.
  • “Late Arrival” : any patient who arrives at the clinic 10 minutes after the expected arrival time for the scheduled appointment.
Policy: It is the policy of the practice to monitor and manage appointment confirmations, no-shows and late cancellations. PsychNW’s goal is to provide excellent care to each patient in a timely manner. We consider the time set aside for your appointment to be yours alone. For this reason, we do not double book our schedule or accept drop in appointments. Consequently, if you cancel your appointment, especially at the last minute, our entire practice is affected. If it is necessary to cancel an appointment, patients are required to call or leave a message at least 24 hours before their appointment time. Notification allows the practice to better utilize appointments for other patients in need of prompt care.

Please Initial the boxes below

Patient Name
A patient is notified of the appointment “Confirmation, No-Show, Late, & Cancellation Policy” at the time of scheduling. This policy can and will be provided in writing to patients at their request.
A patient must respond to a confirmation phone call or text from the office for the date and time of the scheduled appointment. If a patient does not confirm the appointment 48 hours prior to the appointment date, the appointment is subject to cancellation
  • a. Appointments must be confirmed 48 hours prior to scheduled appointment time, otherwise will be subject to cancellation.
  • b. Appointment must be canceled at least 24 hours prior to the scheduled appointment time.
  • c. In the event a patient arrives late as defined by “late arrival” to their appointment, and cannot be seen by the provider on the same day, they will be rescheduled for a future clinic visit, if available.
  • d. In the event a patient has incurred two (2) documented “no-shows” and/or “same-day cancellations,” the patient may be subject to dismissal from PsychNW. The patient’s chart is reviewed and dismissals are determined by a provider only, no exceptions, in accordance with PsychNW guidelines.
  • a. Appointments must be confirmed 48 hours prior to scheduled appointment time, otherwise will be subject to cancellation.
  • b. Appointment must be canceled at least 48 hours prior to scheduled appointment time.
  • c. In the event a patient arrives late as defined by “late arrival” to their appointment, PsychNW reserves the right to reschedule the examination.
  • d. In the event of two (2) documented “same-day cancellations,” the patient may be subject to dismissal from PsychNW. The patient’s chart is reviewed and dismissals are determined by a provider only, no exceptions, in accordance with PsychNW guidelines.
  • a. Without 24 hour cancellation notice the responsible party will be billed $250 for any missed intake appointment.
  • b. Without 24 hour cancellation notice the responsible party will be billed $350 for any missed testing appointment.
  • c. Invoices will be sent to the provided email and are due upon receipt.
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