Please be advised that it is important that you are aware of your responsibilities related to your insurance coverage. I will verify coverage, but it is also important that you are aware of your coverage as well. A card will need to be left on file to cover any missed appointments or no-show appointment fees. Missed appointments or late rescheduling appointment fees are the responsibility of the client. Missed appointments without notice will be charged the entire cost of the session. If you need to reschedule your appointment with less than 24 hours’ notice, you will be charged half the cost of the session.

Signature: