Cancellation/No show policy for VIVAA

We would like to inform you of our office cancellation/no show policy. Our goal is to provide quality individualized medical care in a timely manner. “No-shows” and late cancellations cause inconvenience to those patients who need access to medical care in a timely manner. This policy enables us to better utilize available vascular ultrasound time, provider and physician’s schedule time for our patients in need of medical and aesthetic care. We understand that there are times when you must miss an appointment due to emergencies or obligations for work or family.

Procedure & Ultrasound Cancellation/No show policy for VIVAA

If the scheduled in-office procedure or ultrasound appointment is not cancelled at least 48 business hours in advance or you “no show” (failure to be present at the time of a scheduled visit) for your procedure or ultrasound, you will be subject to a $100.00 cancellation fee; this will not be covered by your insurance company and is required to pay prior to scheduling your next appointment.

Office Visit Cancellation/No show policy for VIVAA

If an appointment is not cancelled at least 24 business hours in advance or you “no show” (failure to be present at the time of a scheduled appointment) to an aesthetic or physician appointment, you will be subject to a $50 cancellation fee; this will not be covered by your insurance company and is required to pay prior to scheduling your next appointment.

How to cancel your appointment

To cancel appointments, please call 425-250-9999. If you do not reach the receptionist, please leave a detailed message including the spelling of your first and last name as well as a phone number where you can be reached on our voicemail.

I _____________________________________ agree to the terms of the cancellation/policy agreement as described above. I understand that I may be subject to a $50/$100 charge if I’m unable to provide adequate advanced notice depending on appointment type.

Signature: __________________________________________ Date: ___________________

Witness: ___________________________________________ Date: ___________________