No Show Agreement Page 1/1 03/24/23
No‐Show Agreement
Quality care for our patients is our priority. When patients “No‐Show” appointments, it has a significant
negative impact on our practice, and the other patients we need to provide care for. Please take a few
minutes to review our no‐show agreement and sign below.
Definition of a No‐Show Appointment
A “No‐Show” appointment is any scheduled appointment in which the patient either:
• Does not arrive to the appointment
• Cancels with less than 24‐hour notice
• Arrives late and is consequently unable to be seen
How to Avoid Getting a “No‐Show”
1. Appointment Confirmation
The clinic will attempt to contact you up to one week prior to your scheduled appointment to
confirm your visit by text message, email or automated call. You can respond to that electronic
communication 24/7 to confirm/cancel your appointment. Or you can call us to confirm.
Appointments must be confirmed by noon the day before, or they may be given to someone else.
2. Always Arrive 10‐15 Minutes Early
When you schedule an office visit with us, we expect you to arrive at our practice 10‐15 minutes
prior to your scheduled visit. This allows time for you and our staff to address any insurance or
billing questions and complete any necessary paperwork before your visit.
3. Give 24‐Hours’ Notice If You Need To Cancel
When you need to cancel or rebook a scheduled visit, we expect you to contact our office no later
than 24‐hours before the scheduled visit. This allows us an opportunity to rebook the vacant
appointment slot with another patient. We do have two‐way texting enabled, if you are unable to
call, it is ok to send us a text message that you cannot make your appointment, and texting is
available 24/7. In some instances, it may also be possible to change your appointment from in‐
person to virtual if you can’t get to the health center, and that could save the appointment from
being a no‐show.
Outcome of “No‐Show” Appointments
• If a patient continually no‐shows appointments, you may be placed on an alternative scheduling
program. This means that we will be unable to give you a scheduled appointment.
• You will still be able to receive services here, but on a walk‐in basis only. When you arrive at the
health center, we will make every effort to have you worked into the providers’ schedule, but
there may be a wait.
• This policy applies to all disciplines: Medical, Dental, Psychiatry and Behavioral Health
I have read the above and understand Nasson Health Care’s “No‐Show” Agreement.
We reserve the right to make amendments to this agreement at any time.
