Late Cancellation, No Show, and Co-payment Policy 1. I understand that I will be charged for my appointment in full if I fail to give at least a 24-hour notice before canceling my appointment. 2. I understand that I will be charged in full for my appointment if I fail to show up for my appointment. 3. I understand that if I am late for the appointment, I will still have to end the session at the allotted time. By signing this, I agree to the above-stated terms and conditions regarding the services I receive from this therapist.Print Name of Responsible Party(Required)Signature of Responsible Party(Required)Your NameYour NameYour NameYour NameDate(Required) Δ