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PAYMENT POLICY

Payment is due at the time of treatment. We accept cash and checks only.

In consideration of other people who may be on a waiting list for appointments, we ask that you give us at least 24 hours notice in advance of an appointment that will not be kept.

All appointments that are cancelled with less than 24 hours notice, or are missed altogether without notifying our office, will be charged a $15 fee payable at the next visit.

We do recognize that emergencies and difficult situations arise, and would be happy to consider those on an individual basis.

I agree to the above policy:

Print name: ________________________________________________________

Signature: _________________________________________________________

Date: ______________________________________________________________