Please enable JavaScript in your browser to complete this form.

When you schedule an appointment with Family Practice Associates we set aside enough time to provide you with the highest quality care. Should you need to cancel or rescheduled an appointment please contact our office as soon as possible and no later than 24 hours prior to your scheduled appointment. This gives us time to schedule other patients who may be waiting for an appointment. With that in mind our office has implemented a “three strike” policy for no shows.

  • A patient who fails to show for their scheduled appointment or cancels/reschedules an appointment and has not contacted our office with at least a 24 hour notice will be considered a No Show.
  • A letter may be sent after the first and second no show to remind patients of this policy.
  • If a third No Show occurs the patient will be dismissed from the Practice and will be sent a letter of dismissal and instructed to find another primary care physician.
  • Any NEW PATIENT who fails to show for their initial visit will not be rescheduled without permission of the office manager.
  • As a courtesy, when time allows, we make reminder calls for appointments. This is a courtesy and should NOT be expected. If you do not receive a reminder call or message, the above Policy will remain in effect.

We understand there may be times when an unforeseen emergency occurs and you may not be able to keep your scheduled appointment. If you should experience certain circumstances please contact our Office Manager, who may be able to waive the No Show penalty.

I have read and understand the Medical Appointment Cancellation/ No Show Policy and agree to its terms.

Electronically Signed
I, the undersigned, acknowledge and agree that by typing my name, clicking “I Accept,” or by other electronic means, I am signing this document electronically.
Date / Time