Patient Acknowledgement Appointment Cancellation Policy
Dear Esteemed Patients,
In order to better serve you, Freedom Spine & Pain will now be adhering to our
appointment cancellation policy. A cancellation made within less than a 24-hour
notice significantly limits our ability to make the appointment available for another
patient in need.
To remain consistent with our mission to provide the best patient care, we will be
enforcing the following policy:
1. Please provide our office with 24-hour notice if you need to reschedule your
appointment. This will allow us the opportunity to provide care to another
patient. A message can always be left on our voicemail to avoid a cancellation
fee being charged.
2. A “No-Show”, “No-Call” or missed appointment, without proper 24-hour
notification, you are liable to the fees listed below. This fee is not billable to
your insurance.
OFFICE VISIT CANCELLATION OR NO SHOW $50.00
OFFICE VISIT WITH PROCEDURE CANCELLATION OR NO SHOW $75.00
PROCEDURE CANCELLATION OR NO SHOW $150.00
ANESTHESIA CANCELLATION OR NO SHOW $100.00
FMLA/DISABILITY PAPERWORK $50.00
