Chiropractic Appointment Reminder Letter Template printable pdf download

Chiropractic Appointment Reminder Letter Template

APPOINTMENT REMINDER FORM FOR CHIROPRACTIC PATIENTS

Date: ____________________________________________________________

Name: ____________________________________________________________

Please check the box with the preferred way you choose to be notified of your

appointment time (Please only select one option).

Phone call reminders are no longer available for Chiropractic appointments.

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Email ________________________________________________________

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Text Message __________________________________________________

Cell Phone Carrier (Verizon, AT&T, Sprint, Etc…) _____________________

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No reminder

Reminders will be given 48 hours in advance for all appointments.

MISSED APPOINTMENTS:

A 24 hour cancellation policy is in effect for all chiropractic services. We reserve

the right to charge for missed appointments. If 24 hour notice is not given, you will

be billed $30 for the session. If less than 24 hour notice is given, every effort by our staff

will be made to fill the appointment from the Waiting List. If it cannot be filled, you will be

charged.

For VA patients – If you miss more then 3 appointments without a 24 hour

cancellation, our only recourse is to discontinue care.

Chiropractic Appointment Reminder Letter Template