Core Physical Therapy asks that you make it your responsibility to attend the appointment that you schedule. If you need to cancel or reschedule, please do so 24 hours in advance. If you are forced to miss an appointment or cancel without proper notice you will be responsible for the full cost of your visit.

Prices for missed appointments are as follows: $50/half hour visits and $100 dollars/hour visits.

Our individualized approach is for your benefit so we appreciate every effort on your part to attend consistently and allow us time to fill the schedule openings with other clients who may need them.

It is expected that the payment for your missed appointment is paid before your next visit in order to keep your scheduled appointments. By signing this agreement you are accepting the rules and conditions of our office. Core Physical Therapy thanks you for your cooperation and courtesy.

I have read and understand the above policy.

Patient's Name (Printed): _________________________________________________


Signature_________________________________ Date _______________________