Informing Patient of No-Show and Late Cancellation Policy

Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)

DATE

Patient Name
Address
City, State  Zip

Dear______:

When we make your appointment, we are reserving a room for your particular needs. We ask that if you must change an appointment, please give us at least 24 hours notice.  This courtesy makes it possible to give your reserved room to another patient who would like it.

There is a charge for not showing up for scheduled appointments.  Repeated cancellations or missed appointments will result in loss of future appointment privileges.

We feel that our patient's time is valuable.  When your appointment is made, a room is reserved, your records are prepared, and special instruments are readied for your visit.  Except for emergency treatment for another patient, you can expect us to be prompt.  We, of course, would appreciate the same courtesy from you.

Sincerely,

 

Dr. ______