I agree that, in order to benefit (or not negatively impact) other patients who are also in need of medical care, I will cancel any established appointments I have in advance of my given appointment date. I understand and agree that not showing up for my scheduled appointment, without a confirmation or cancellation, in advance, is considered a factor in whether I am allowed to continue to receive medical care from Dr. Tarbox. In addition, I understand and agree that there is a $200 fee, per PROCEDURE appointment missed & without providing at least 24 hr advance notice, and $100 fee, per OFFICE VISIT appointment missed & without providing at least 24 hr advance notice, which may be billed unto me. I understand that this amount is solely my responsibility (and not my insurance company). Appointments must be confirmed at least one day prior to the scheduled appointment date.
I understand that if I am scheduled for a Follow-up visit, I am to arrive no later than 15 minutes prior to my scheduled appointment time, in order to complete the check-in process, which includes providing all of my current demographic information, including my contact information (i.e. cell phone, or other preferred phone number).
I understand that if I am scheduled as a New Patient or, if I have not yet completed the Pt. Registration Packet, or other paperwork, as may be required of me by clinic staff, I will arrive no later than 45 minutes prior to my scheduled appointment time.