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Forms

Cancellation Policy

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At SurgOne, P.C., we strive to render care in a timely and prompt manner. When a patient misses a scheduled appointment, or cancels an appointment with minimal notice, not only is that time lost, but it negatively impacts our ability to schedule other patients that require medical care. SurgOne, P.C. has thus adopted the following SurgOne, P.C. Cancellation Policy. By signing below, you hereby acknowledge and agree to the following:

  • Any patient that fails to show up for a scheduled appointment, or cancels a scheduled appointment with less than 48 hour's notice, may be charged a SurgOne, P.C. Cancellation Fee.
  • Cancellation Fees can range from $25.00 up to $200.00 depending on the length of the appointment and the specialty of the provider with whom it was scheduled. SurgOne, P.C. can provide the exact amount of a Cancellation Fee at the time an appointment is scheduled.
  • All outstanding Cancellation Fees must be paid in full prior to the scheduling of a patient’s next appointment with SurgOne, P.C..
  • Patients are solely responsible for the payment of Cancellation Fees, not insurance companies, Medicare, or other third-party payers.
  • Any patient who, in a given 12-month period, misses three or more scheduled appointments, or cancels three or more scheduled appointments with less than 48 hour's notice, may be dismissed as a patient from SurgOne, P.C..

We will be happy to address any questions you may have after reading our SurgOne, P.C. Cancellation Policy. Please let our staff know if you would like a copy of this policy.