5006 Veterans Highway
Holbrook NY 11741
Phone: 631-275-8906
Fax: 631-218-8656
CANCELLATION AND NO SHOW POLICY
Effective as of 11/04/2015, patients who cancel/no show to any appointment will be
charged a $25.00 cancellation fee unless able to reschedule appointment for that current
week based on availability. Due to our individualized one-on-one care, missed
appointments are a significant inconvenience to your physical therapy, the clinic, and
other patients.
We realize that emergencies and other scheduling conflicts arise and are sometimes
unavoidable, however, we need to fulfill all of our patients’ scheduling needs and keep
the clinic operating at its most efficient level.
This fee will be billed to your home address and must be satisfied by the end of the
current month.
Out of respect for other patients we ask that you please arrive on time for your
appointments. Because the therapist has scheduled individual time with you, lateness
will result in a reduced treatment session.
We thank you and greatly appreciate your cooperation.
-The Management and Staff at Max Effort PT
I have read and understood the above information:
Patient Signature: _______________________________________
Witness: _______________________________________________