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Home » No Show Policy Form

No Show Policy Form

We understand that situations may arise in which you will need to cancel or reschedule your appointment. However, each time a patient misses an appointment without providing the proper notice, another patient is prevented from receiving care. Therefore, any patient who fails to arrive for a scheduled appointment without canceling or rescheduling the appointment 24 hours prior to the scheduled appointment time is considered a No Show.

Patients who No Show 3 or more times in a 12 month period will be charged a non-refundable $50 fee. No Show fees are the responsibility of the patient or guardian and must be paid in full before a new appointment will be scheduled.

We appreciate your understanding and cooperation.

Please sign below to acknowledge that you have read and understand the Accurate Family Vision patient No Show policy.
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