Appointment Cancellation form

Please be aware there is a $50 Cancellation Fee if less than 24 hour notice is given to cancel an Office Visit and a $100 Cancellation Fee if less than 24 hour notice is given for Surgical Procedures. If an Office Visit is canceled near a patient's refill date, it is possible the patient will either need to be seen for an office visit before a refill can be given or there may be a 5 business day delay to receive the prescription refill. If you have any questions regarding medications or need to reschedule your appointment to a new date, we encourage you to call our office at your convenience! Thank you.



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