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Madison Pediatrics

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Our missed appointments policy is in place to help discourage missed appointments which can inconvenience other families who might have been able to use that appointment time slot.

Missed appointments are appointments not kept, or for which you arrive more than 20 minutes late but still want to be seen, and for which you do not provide a minimum of 24 hours advance notice. They are tracked for one (1) year.

If an appointment is not kept and/or we were not notified that the appointment needed to be changed more than 24 hours before the scheduled time, you will be charged a “missed appointment fee.”
 

BE AWARE: Insurance and Medicaid do not cover this fee. You are responsible for this charge.

Our current missed appointment fees are as follows:

• First missed appointment: $30
• Second missed appointment: $35
  (Also applies to 2nd missed appointment on the same day, for instance 2 children who both miss appointments on the same day)
• Third missed appointment: $40
  and you will be asked to seek medical care elsewhere (Also applies to 3rd missed appointment on the same day, for instance 3 children who both miss appointments on the same day)

By signing this notice, you acknowledge this policy and your responsibility for its consequences and charges. (Acceptance is required for all families.) 

Parent/Guardian/Primary Caregiver

Form to be added