Deborah L. Ungerleider, MD, LLC
Deborah L. Ungerleider, MD, LLC

Cancellation Policy

Deborah L. Ungerleider, MD, LLC

Pediatric and Adolescent Medicine

44 Godwin Avenue

Midland Park, New Jersey 07432

(201) 444-8389

Fax (201) 444-2309

 

 

 

Cancellation Policy

 

 

Your health/child’s health is very important to this office, as well as your time.  We recognize that unavoidable emergencies do occur.  If for any reason you need to reschedule an appointment, please call this office within 24 hours to allow us the opportunity to schedule another patient.  Missed appointments with little or no notice may result in charges.

 

We appreciate your understanding and anticipated cooperation in this matter.

 

 

__________________________________________

Patient’s Name

 

 

__________________________________________

Parent’s Signature                               Date

 

 

__________________________________________

Patient’s Signature (if 18 or older)               Date

To print out this form, click on the link below.

Cancellation Policy.doc
Microsoft Word document [23.5 KB]

Where to Find Us:

Deborah L. Ungerleider, MD, LLC

44 Godwin Ave Suite 100

Midland Park, NJ 07432

 

(201) 444-8389

 

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© Deborah L. Ungerleider, MD, LLC