Appointment Cancellation

If you need to cancel an upcoming individual appointment, please complete the form below. Please do not call the office or contact your child’s therapist directly with cancellation requests.

"*" indicates required fields

Name*

First Last

Email*

Child's Name*

Cancellation Reason*

Sick

Vacation

Other

Scheduled Appointment Date to Cancel*

Please enter the date of the appointment you would like to cancel

Scheduled Appointment Time*

Hidden

Date Today

Hidden

Time Now

Hidden

Hours

Next Steps*

Reschedule to a different date

Cancel the appointment without rescheduling

Other

Per our policy, cancelling an appointment less than 24 hours in advance (except for legitimate emergencies) is considered late cancellation.

Next Steps for Late Cancellations*

Reschedule missed appointment

Pay for late cancellation (refer to cancellation policy)

Your missed appointment must be rescheduled prior to your next scheduled appointment to avoid a no-show charge.

If an appointment is not scheduled prior to your next scheduled appointment or you cancel the rescheduled appointment, a no-show charge will be applied to your next invoice. Insurance generally does not cover missed or late-canceled appointments.

We prefer not to charge no-show fees so your child could benefit from continued therapy but staffing and facility expenses are incurred when we make appointments available to you with our staff. Giving advance notice of a cancellation allows time for others who need services to reserve the appointment time instead.

Please provide your availability for the next week*

Please note, we will try to accommodate your availability with one of our therapists but this is not guaranteed. Please specify dates and times. We will contact you to confirm if these times are available or offer available appointment times.

Cannot cancel a past appointment.

Late Cancellation Fee

Price:

Credit Card*

Card Details

Cardholder Name

Name

This field is for validation purposes and should be left unchanged.

Appointment Cancellation

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