Patient Name (Printed): __________________________________________________ Date: __________________
Our goal is to provide each patient with quality aesthetic care in a timely manner. We have implemented a “No Show and Cancellation Policy” which enables us to better utilize available appointments for our patients.
The following policy is in regards to patients who fail to keep their scheduled appointment:
Please contact the office through phone or email as a courtesy if you are unable to attend an appointment. This time will be reallocated to someone else. Appointments are in high demand and your early cancellation will provide another person access to our services. If you have reached out to us after business hours with a phone call, please leave a voicemail with your first and last name, contact number, appointment date and time, and reason for cancelling. If you wish to reschedule, please leave preferred days and times and we will get back to you on the following business day.
Patients who fail to show for their scheduled appointment shall be subject to a no-show fee of $100. In the event of an emergency where prior notice could not be given and you miss your appointment, a one-time exception may be granted. Patients who cancel within 24 hours of their scheduled appointment time shall be subject to a cancellation fee of $50. If an appointment is cancelled due to the physician or esthetician being absent, the patient is not subject to a charge.
After the occurrence of 3 no-shows or same-day cancellations, a deposit for the total of the service (up to $500) will be collected during scheduling. For undetermined treatment costs, like filler or neurotoxin, a deposit of $500 will be collected during scheduling. If there are any additional no-shows or same-day cancellations the deposit will be lost. Any previous no-shows or same-day cancellations that have occurred will count towards this total.
Patient Name (Signature): ________________________________________________________________________