Individual pediatric PT session

Cancellation Policy

Dear Patient, Children's Therapy and Wellness Center, LLC has instituted an Appointment Cancellation Policy. A cancellation made with less than a 24 hour notice significantly limits our ability to make the appointment available for another patient in need. To remain consistent with our mission, we have instituted the following policy: 1. Please provide our office a 24-hour notice in the event that you need to reschedule your appointment. This will allow us the opportunity to provide you with an alternative time for therapy and provide care to another patient. A message can always be left with the answering service to avoid a cancellation fee being charged. 2. A “No-Show”, “No-Call” or missed appointment, without proper 24-hour notification, may be assessed a $50 fee. 3. This fee is not billable to your insurance. 4. If you are 15 or more minutes late for your appointment, the appointment may be cancelled and rescheduled. 5. As a courtesy, we make reminder calls/SMS, for appointments, one to two days in advance. Please note, if a reminder call or message is not received, the cancellation policy remains in effect. 6. Repeated missed appointments may result in termination of the physician/patient relationship. If you have any questions regarding this policy, please let our staff know and we will be glad to clarify any questions you have. A copy of this policy will be provided to you. Please sign and date below your acknowledgement. I have read and understand the Appointment Cancellation Policy and I acknowledge its terms. I also understand and agree that such terms may be amended from time-to-time by the clinic. _________________________________________________________________ Printed Name of Patient Signature of Patient Date

Contact Details

• 23 Spring Hill Drive, West Orange, NJ, USA

  2012409816

  beatrice@childrenstherapyandwellness.com