Appeal for Missed Appointments Form
Your time is very important and so is ours. We do not double-book our patients when you schedule an appointment, that time has been reserved specifically for you. To protect our providers, to continue to provide patients with their own time that is not double-booked, and to protect other patients who may have been able to utilize an appointment time with advanced notice, we do have a 24-hour cancellation policy. For patients who do not provide 24-hour notice, SLBMI does charge 60% of the list price cost of your session. To also be fair across all patients, we enforce this policy without attempts to judge a patient’s reason for not providing notice for cancellation. This decision is not to invalidate anyone’s reason for not providing 24-hour notification; rather, again it is in recognition that we do not want to treat our patients unequally or unfairly.
However, if you believe you have been incorrectly charged a missed session fee and/or wish to request a waiver of the missed session fee, we invite you to complete the following form. Please do keep in mind that our Missed Session policy remains intact and typically only documented extraordinary circumstances result in waiver of valid missed session fees. Completing this Missed Session Appeals Form does not guarantee that the cancellation fee will be waived.