Notification of Missed Appointments and Insurance Coverage
Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 24 hoursadvance notice of cancellation. Please understand that when you forget or cancel yourappointment without giving enough notice, we miss the opportunity to fill that appointment time, andclients on our waiting list miss the opportunity to receive services. Since the services are reserved foryou personally, a Cancellation fee will apply. We now require that you provide a credit card to have onfile to be charged for missed appointments or the cost of assessment, testing, therapy and/or Biofeedback/Neurofeedback training sessions that are not covered by insurance.
I understand I will be financially responsible for any services received at InMindOut that are not covered through my insurance.
By signing below I indicate I have read the information in this document and agree to abide by its terms.
If client is a minor, please have the parent or legal guardian sign this form.
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Notification of Missed Appointments and Insurance Coverage
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