No Show/Cancellation Policy |
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This policy is created to increase our ability to respectfully care for all patients in a professional and timely manner, by offering open appointments times to patients who are in need. Patient Requirements:Patients unable to make their scheduled appointment are required to notify our office by calling 816-229-1191, as follows:
Patients are responsible for maintaining current personal contact and insurance information with our office. Please review this information on each visit. Outdated patient information is the number one reason insurance companies deny claims. Denied claims are due and payable immediately from the patient. Jackson County Gastroenterology Guidelines:
PLEASE listen carefully to all messages and/or return all calls from our office or facility promptly. If we do not receive a confirmation from you within the time frames noted above, your appointment or procedure will be cancelled. If you confirm and do not come to the appointment, you will be charged the ‘No Show’ fee. No exceptions. The best way to reach me is: __________________________________________________ I have read and understood the above policy and agree to abide by the guidelines as outlined, pay any fees I incur, and any additional fees incurred in the attempt to collect unpaid debts.
Patient Signature ________________________________ Date _________________________ Printed Patient Name ______________________________ DOB _________________________ |