Skip to main content
Hit enter to search or ESC to close
Close Search
Menu
Home
About
Services
Forms
Resources
Developmental Charts
Glossary
FAQs
Testimonials
Privacy Policy
facebook
instagram
phone
C
o
n
t
a
c
t
U
s
Attendance / Cancellation Policy
Please enable JavaScript in your browser to complete this form.
Attendance and participation in therapy along with complete compliance with any associated home programs are essential for therapeutic success.
While Branched Out Therapy, Inc. understands that illnesses and emergencies occur, we respectfully request that you avoid frequent cancellations or “no-shows.” Please adhere to our following policy regarding providing our office with advance notification for any cancellations resulting from a conflicting appointment, vacation, obligations for work or family, or any other event.
All cancellations must be submitted 24 hours prior to your scheduled appointment.
Branched Out Therapy Inc. will waive
one
cancellation/no show within a calendar year with no penalty.
A fee of 50% of session cost may be assessed if the following occurs. This fee will be billed directly to the client and not their health insurance company, as medical insurance does not provide coverage for missed sessions.
If cancellations are made less than the required 24 hours.
If the client fails to show up for a scheduled appointment.
If you reschedule/are late for 4 scheduled appointments within 30 days, the office will reserve the right to discharge the client. Additionally, if you arrive late for a scheduled appointment, the session will still end at the scheduled time or may be canceled.
If you fail to appear for an appointment (no show) without providing the appropriate advance notification for 3 or more appointments within 30 days, the office will reserve the right to cancel all pending appointments and to no longer offer services to you as a client.
I understand the attendance/cancellation policy and the risks of not adhering to it.
Layout
Signature of Client or Legal Representative
*
Relationship to Client
*
Submit
Close Menu
Home
About
Services
Forms
Resources
Developmental Charts
Glossary
FAQs
Testimonials
Privacy Policy
Contact Us
facebook
instagram
phone
Skip to content
Open toolbar
Accessibility Tools
Accessibility Tools
Increase Text
Increase Text
Decrease Text
Decrease Text
Grayscale
Grayscale
High Contrast
High Contrast
Negative Contrast
Negative Contrast
Light Background
Light Background
Links Underline
Links Underline
Readable Font
Readable Font
Reset
Reset