Session a Cancellation
Our policy requires at least 2 hours advance notice of cancellations for your scheduled session. This promotes consistency for staff and clients.
Date of Submission
Person Completing Form
Please Select
Staff Member
Parent/Guardian
Admin Staff
Patient Name
First Name
Last Name
Staff Name (Optional for Families)
First Name
Last Name
Date to Cancel
-
Month
-
Day
Year
Date
Which Sessions are Cancelled?
Please Select
Morning Session 8:30-11:30
Afternoon Session 12:30-3:30
Afterschool Session 4-6pm
All Day
If Multiple Days & Times, Please Note Below
Reason
Reminder of Cancellation Policy for Families
Attendance Requirement Percentage. If a learner is unable to attend at least 80% of the monthly recommended hours, the patient’s schedule will be faded by 50% of scheduled hours for the subsequent month. (Ex: If they are scheduled for 20 hours/wk, the next month they will be scheduled for 10 hours/wk). If the cancellations continue, the client’s services will be terminated and referred out. A full copy of the policy is available in the JHW Family Policy Handbook.
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