NO SHOW / CANCELATION POLICY

48 Hour Cancellation & “No-Show” Fee Policy

Each time a patient misses an appointment without providing proper notice, another patient is
prevented from receiving care. Therefore, Eye Life Vision Center reserves the right to charge a
fee of $50.00 for all missed appointments (“no shows”) or appointments canceled within 48
hour from their schedule time. Some practices will overbook the schedule in anticipation for No-Shows. However, this can result in patients having to stay longer than anticipated. We strive to
get patients in on their scheduled time because we understand time is valuable to everyone.
 
“No Show” fees will be billed to the patient. This fee is not covered by insurance, and must be
paid prior to your next appointment. Multiple “no shows” in any 12 month period may result in
termination from our practice. Thank you for your understanding and cooperation as we strive to
best serve the needs of all of our patients.
 
By signing below, you acknowledge that you have received this notice and understand
this policy.
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