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 Melissa Coyle, LCSW-R


Client’s can cancel or reschedule an appointment anytime, as long as you provide 24 hours notice. If you cancel with less than 24 hours notice, or fail to show up, you will be charged the full amount for the session. This is not meant to be a penalty or punishment. This cancellation policy is really important to my practice because I reserve for you, and all my clients, a full hour of my time for the 45 minute session and session notes. If a client cancels with less than a FULL 24 HOUR NOTICE or is a no-show, I will not be able to fill that time slot and I will loose an entire hour from my work schedule. By reading and signing this form you acknowledge, understand and agree to abide by my cancellation policy.



Client Signature




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