Your appointment time is reserved for you. Please read this policy and sign below before your first visit. Effective October 10, 2026.
Notice. Please give at least 24 hours' notice to cancel or reschedule. Call (360) 836-9398 or email lisa@lisapsych.com, and do not include medical details.
Fees. A cancellation with less than 24 hours' notice, or a missed visit, may be charged $75 for an initial evaluation or $50 for a follow-up. Your first missed appointment is waived.
Late arrival. If you have not joined within 15 minutes and have not contacted the practice, the visit may be counted as missed.
Connection trouble. If you are having trouble connecting, call or text right away.
Insurance. This fee is not covered by insurance and does not apply to patients with Medicare or Apple Health.
Emergencies. Fees are waived for emergencies or documented circumstances beyond your control.
Repeated misses. If you miss several visits in a year, we will talk about an attendance plan. Discharge with referrals is a last resort.
I have read and understand this policy and agree to it. I understand I may be charged the fees above.
Patient name (print)
Signature
Date
If signed by a personal representative: name and relationship to patient