Cancellation Policy


 

 

Cancellation & No Show Policy

Patient Name______________________________   DOB_________________

It is the policy of TARPON PA to bill a cancellation fee to a patient that does not show or cancel at least 24 hours in advance of a Procedure, EMG, Surgery or follow up appointment. This is to ensure that our treatment team is using their time to diagnose and treat patients that are in need of our services. A patient that arrives 20 minutes past the time of the appointment will be considered a “no show” for the purposes of this policy. Fees for no show appointments will be as follows:

Procedure $100.00

EMG $100.00

Surgery $100.00

Clinic visit $50.00

 

 

Please sign below indicating you have read and understand this policy.

 

 

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Patient Signature

 

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