Appointment Cancellations

Appointment Cancellations

Please complete the form below if you need to cancel an upcoming appointment.

Client Name*

Parent/Guardian Email*

Type of Appointment*

Select or enter value

Speech Provider*

Select

OT Provider*

Select

Academic Provider*

Select

Other Provider*

Select

Date of Service*

Please enter any details you'd like your provider to know.

I acknowledge that cancellation of an appointment with less than 24 hours notice may result in a $50 cancellation fee.*

Send me a copy of my responses

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