Unitedhands Health & Wellness Clinic Medical Appointment Cancelation/No Show Policy

Any patient who fails to cancel his or her appointment within 24 hours of scheduling and has a no show for their visit will be charged a one-time fee of $99.00• The fee is charged to the patient’s credit card on file, not the insurance company, and is due at the time of the no show and or cancelation outside of 24 hours.

In order for your appointment to be confirmed, please complete card information below. A form will be send to your email or text asking you to complete the needed information before your appointment can be confirm.

1-Time Credit Card Payment Authorization© for No show/late cancelation Fee Sign and complete this form to authorize Unitedhands Health & wellness Clinic LLC to make a one-time charge to your credit card listed below. By signing this form, you give us permission to debit your account for the amount indicated. An email will be send to you to complete prior to confirming your appointment. Your appointment is not confirmed until you complete complete the form that we will send to you and resend the form back to us. Thanks.