No Show / Late Cancellation Policy

This policy has been established to help us serve you better. We schedule appointments to see patients as efficiently as possible. No-shows and late cancellations cause delays for other patients, including those who may be seriously ill, and result in underutilized resources.

Definitions:

No-Show: Missing a scheduled appointment without prior notice.

Late Cancellation:

Office Visit: Canceling less than 24 hours before the scheduled time.

Fees: $25.00 fee for each office visit no-show or late cancellation..

Note: These charges are not covered by insurance and are the patient's responsibility.

We understand that medical or personal emergencies can arise. These will be reviewed on a case-by-case basis.

To cancel or reschedule an appointment, please call:

Centra Internal Medicine (623) 594-4126

Please speak directly with an operator.

Patient Acknowledgment

I have read and understand the Centra Internal Medicine No Show / Late Cancellation Policy. I agree to the terms outlined above.

Patient First Name: *

Patient Last Name: *

Email Address *

Phone Number *

Date *

Patient Signature *

Use your mouse or finger to sign in the box below.

Centra Internal Medicine

Centra Internal Medicine

No Show / Late Cancellation Policy

Forms Sent!