Total Health Patient Information Form

Patient Intake Form

Patient Rights and Responsibilities »

Notice of Privacy Practices »

Cancellations and Missed Appointments »

Rights and Responsibilities of the Practice

Please print and complete each of the forms listed above prior to your first visit. If you prefer to fill them out in our office, we will happily provide the forms to you. Please allow 15-20 minutes before your appointment to complete the forms in the office.

Cancellation/Missed Appointment Policy:

In the event that you are unable to attend your appointment, we require notice at least 24 hours or one business day prior to your appointment.

When you schedule an appointment with our practice, that time is reserved for you. It is our policy that patients are responsible for all appointments that they have scheduled. Patients who choose not to attend, or those who call to cancel their appointments at the last minute are still responsible for these appointment times. Therefore the following policy will apply:

• 24 HOURS/ 1 BUSINESS DAY NOTICE IS REQUIRED TO CANCEL EACH ONE HOUR APPOINTMENT YOU HAVE SCHEDULED (Example: 2 hours scheduled = 2 business days’ notice; 3 hours scheduled = 3 business days’ notice)
• CANCELLATIONS MUST BE MADE BY PHONE OR EMAIL
• ANY LATE CANCELLATIONS OR MISSED APPOINTMENTS WILL BE CHARGED THE FULL AMOUNT OF THE REGULAR VISIT

Fees for missed appointments and/or late cancellations are expected at or before the patient’s next scheduled appointment.

For the complete policy details, please see the form above.