CANCELLATION POLICY
To maintain my ability to care of my clients, payment is required at the time of service. Payment may be made by cash, check or credit card (Visa and Mastercard). A credit card will be required to reserve an appointment.
Your credit card will not be charged unless that is how you choose to pay or if you miss an appointment with less than 24 hours notice. The exceptions are health and weather emergencies. You will be called if the office is closed due to weather emergencies.
I also respect your time. If I miss an appointment (for reasons other than emergencies or illness) without giving you at least 24 hours notice, your next session will be free of charge.
Please fill in the information below: this information will be kept as confidential.
Credit Card: (Circle One) Master Card Visa Discover
Credit Card Number: ____________________________________
Expiration Date: ________________________________________
Three digit code on the back of the credit card ________________
Name on Credit Card ____________________________________
Billing Address used for this Credit Card ____________________________
____________________________
____________________________
I understand that I will be charged the full cost of a missed appointment if I do not cancel before 24 hours preceding my appointment.
Your Signature _______________________ Today’s date__________
Your credit card information will be kept in your confidential file and will not be accessible to anyone else.