The Spine and Wellness Center
Medical/Spa Appointment Cancellation Policy
We strive to render excellent care to you and the rest of our patients and clients. Your care and treatment is a priority to us. We also ask that you respect your therapists and physicians time and expertise as well. In an attempt to be consistent with this, we have a Medical/Spa Appointment Cancellation Policy that allows us to schedule appointments for our patients, with respect for your time, the next patients time, and the doctor and therapists time. Our policy is as follows: We request that you give 24 hours notice in the event that you cannot make it to your scheduled appointment. If a patient misses an appointment without contacting our office, it is considered a “missed” or “no show” appointment. YOU WILL BE CHARGED THE AMOUNT OF THE VISIT YOU WERE SCHEDULED FOR! The fees for the appointments are listed below, and will be charged to your credit card. Additionally, if a patient is more than 15 minutes late for an appointment, it will be considered a “missed” or “no show” appointment, and that appointment will be rescheduled. Also, if you miss more than 3 appointments, Dr. Borja reserves the right to discharge you from the practice for failing to follow treatment recommendations. If you have any questions regarding this policy, please let our staff know, and we will be happy to clarify the policy for you. We look forward to being a continued part of your wellness. I have read and understand the Medical/Spa Appointment Cancellation Policy of The Spine and Wellness Center, and I agree to be bound by its terms. I am aware that my credit card will be charged for the missed appointment, and I agree to these terms. I, _______________________________, have received a copy of The Spine and Wellness Center Medical/Spa Appointment Cancellation Policy. ______________________________ ______________________________ Signature of Patient Witness ___________ _____________________ ________ ________ Credit Card Number Exp CVV __Chiropractic $48 __Massage $45 __Personal Training $45 __Skin Care $60 __Laser Treatment $75 __Special Services $100
