Appointment Confirmation Agreement Page


We value you as our patient and need your cooperation with keeping appointments so that we can provide the best care for you and your family. Missing or late canceling an appointment means we are unable to fill this appointment time with another patient who desperately needs care.

Check-in/Late Policy 

We encourage our new patients to arrive 10-15 minutes before your appointment time because there is a lot of information we are confirming/updating/uploading into our system to establish your child in our clinic.   

Patients who arrive more than 20 minutes late may be rescheduled.     

Cancellation/No Show Policy 

You must give us at least 24 hours advance notice if you cancel your appointment.  We prefer a phone call to notify us so that we can help you to reschedule your appointment.  Failure to notify us will result in a $30 “No-Show” fee.     If you have 3 “No-Shows,” you may be discharged from the clinic.  

Same-day appointments/Appointments made within less than 24 hours  

Failure to show to your same-day appointment or appointment that is within less than 24 hours will result in a $30 “No-Show” fee.  

Mandatory Appointment Confirmation Policy  

Patients/Parents are required to confirm their appointment to keep your appointment time.  

There are 3 ways that you can confirm: 

#1 AUTOMATIC TEXT MESSAGE: 2 days prior to your appointment (if it was made more than 2 days in advance), you will receive an automatic text message that will ask to confirm or cancel your appointment.   

#2 PHONE CALL: One of our staff members will call you to confirm your appointment more than 24 hours in advance.  If you miss the phone call, feel free to call us back to confirm over the phone.  You have the opportunity to reschedule or cancel for whatever reason you are unable to come.  We understand that each child may have multiple caregivers, but it is not possible for our staff to call every phone number on file.  Please note that we will only call the main designated phone number.   

#3 TEXT MESSAGE: We understand that many of our parents are unable to pick up their phones during work hours or may miss the phone call so as a courtesy, we will also text you to confirm your appointment.  At that point, you must respond or else we will cancel your appointment.  Please note that we will be texting the main designated phone number.

We do not accept walk-ins at this time.  All appointments must be scheduled.  We often have same-day sick appointments available so please call first to see if we can accommodate your child.  Otherwise, you may need to visit your nearest Urgent Care or ER if you need to be seen immediately.     

Payment Options 

We accept cash or debit card ONLY.  Credit Cards are NOT accepted at this time.

Complete the fields below to confirm you have read and agree with the statements above.