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:
Clinic visit $50.00
Please sign below indicating you have read and understand this policy.