Southern Minnesota Behavioral Health is committed to providing exceptional, quality care; however, this is impossible without consistent follow-up visits with your provider. No shows and late cancellations are costly to the practice and limit access to care for other patients. Your appointment time has been reserved for you; therefore, please have the courtesy to attend your follow-up visits as scheduled. If you cannot keep your appointment, contact us to cancel/reschedule in accordance with practice policy.

Patient Cancellation and No Show* Policy:

1. After one missed (no show) scheduled appointment, a phone call will be made to the patient.
2. After two missed (no show) scheduled appointments in a month, the patient will be sent a warning letter.
3. After three missed scheduled appointments, the patient could be discharged from the practice.
4. All no-show/late cancelled appointments are subject to a $50.00 fee.
It is the patient’s responsibility to notify Southern Minnesota Behavioral Health of a cancellation at least 24 hours (1 day) in advance of the scheduled appointment to avoid the no show fee. Appointments cancelled less than 24 hours in advance are considered a no show and may be charged the $50.00 fee.
* No shows are calculated based on a consecutive 12-month period.
Please arrive 15 minutes prior to your appointment to complete the check-in process. If you arrive after your scheduled appointment time, you may be asked to reschedule and be charged a no-show fee.
NOTE: Emergencies arise from time to time and a late cancellation cannot be avoided. The Southern Minnesota Behavioral Health team will review emergency situations on a case-by-case basis.

I have read and understand the Southern Minnesota Behavioral Health patient cancellation and no-show policy:

Patient (or Guardian) Signature(Required)
MM slash DD slash YYYY
Print Name(Required)
Call Now