Missed Appointments

To provide you the best possible care and increase access for all our patients, please cancel your appointment at least 24 hours in advance so that others may have the opportunity to be seen. Appointments may be cancelled on the Patient Portal or via phone or in person.

A “No Show” fee will be charged to your student account if you do not cancel within 24 hours of your appointment, if you are more than 10 minutes late for the scheduled appointment or do not show at all. This applies to all appointments made at the Student Health Center and Pharmacy.

Name and Contact Information

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address City State ZIP Code

Appointment Information

Date of Appointment(Required)

Date of Charged Fee(Required)

Reason for Appeal Request *(Required)

SUBMISSION AGREEMENT(Required)

I understand that the appeal process is not a guarantee of reversal of the no-show/late cancellation fee. After this form is received it will be given consideration and we will provide a written response at the address listed above.

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