No-Show and Cancellation Policy Acknowledgment Form
Please review and acknowledge our no-show and cancellation policy by completing the information below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Appointment or Booking Reference Number
*
Date of Appointment or Booking
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Visit or Booking
*
Preferred Contact Method
*
Please Select
Email
Phone Call
Text Message
No-Show and Cancellation Policy Details
Please carefully read the following policy:
Appointments must be canceled or rescheduled at least 24 hours in advance. Failure to do so may result in a no-show fee or forfeiture of your deposit. Repeated no-shows or late cancellations may affect your ability to book future appointments.
By acknowledging below, you agree to abide by this policy.
Signature
*
Acknowledge Policy
Acknowledge Policy
Should be Empty: