Appointment Cancellation & Forms Fee PolicyT

Focusing On You!

 

Our appointment policy

Please arrive on-time to your scheduled appointment. Late arrivals cause schedule delays for those patients who arrive promptly at their appointment time. Late arrivals will be worked into the schedule if time allows or if you are significantly delayed, you may be asked to reschedule your appointment to another day or on a walk in basis.

 

Cancellation Policy/No Show Policy

We understand there may be times when you miss an appointment due to emergencies or obligations with work or family.  Nevertheless, we encourage you to call at least 24 hours prior to your appointment to cancel. EACH TIME A PATIENT MISSES AN APPOINTMENT WITHOUT PROPER NOTICE, ANOTHER IS PREVENTED FROM RECEIVING CARE. Therefore, HOFFNER EYE CARE reserves the right to charge a fee of $20.00 for a missed appointment without prior notice of 24 hours.  This fee will be payable by statement or at your next scheduled visit.  As a courtesy, we agree to confirm your appointment to your primary phone number from one to three days before your scheduled appointment. 

A no show for two consecutive appointments or a cancellation of a total of three appointments, you may be discharged as a patient absent a compelling reason.

When you give us a 24 hour notice, your reserved time can be made available to another patient.

Forms Fee Policy

There will be a charge $5.00 charge for any Department of Motor Vehicle Report of Eye Exam.  For any scripts that were given to you like medication, eyeglass prescription, and contact lens prescription and you lose them there is a $5.00 fee as well.

Thank you for understanding the value of our cancellation policy and forms fee policy to each of our patients.

 

I understand that these fees are not reimbursable by my insurance carrier.   I hereby acknowledge that I am aware and accept the financial responsibility for fees assessed to my account for any of the above reasons.  I accept the above policy.

 

Patient’s Signature________________________          Date____________________

 

Guardian Signature____________________________