Cancelation Form

CANCELLATION POLICY: I am aware that my therapist will provide a treatment plan to meet my rehabilitation needs. I agree to make every effort to attend my scheduled treatment sessions. If I cancel or no show 3 times within a month or for 3 consecutive scheduled appointments, I may be discharged from therapy and asked to return to my referring physician.

I am also aware that as a patient, if for some reason (other than an emergency) I need to cancel an appointment that it is Oklahoma Surgical Hospital Outpatient Rehabilitation policy that I must notify the office 24 hours priors to my appointment. Failing to do so, that visit will be applied to the cancellation policy.

I am also aware that being late for my scheduled appointment may result in being asked to reschedule that day’s appointment.