Attendance Form

Attendance Contract
KARE 2 COMMUNCATE strives to offer you high quality speech therapy services. Every attempt is made to schedule your services in a timely manner and when possible, at your convenience. Regular attendance is important to achieve progress and success in therapy and it is necessary that all appointments be kept.
Because of the demand for therapy services, recent difficulty with attendance, and to ensure positive outcomes, we must enforce the following attendance policy for every client:
•24 hour notice is required to cancel a session. If you fail to cancel prior to the start of theappointment, this will be counted as a “no show”Initials 01

•If you arrive more than 10 minutes late to your appointment, you will not be seen and this will becounted as a “no show”.Initials
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You may be discharged from therapy for the following reasons:
•2 “no shows” during the course of treatment.
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Initials•Missing more than 3 appointments in a 3 month period (tracked in quarters: Jan-March, April-June,July-September, October-December)
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We will try to make up a missed appointment (for any reason). Rescheduledappointments are only available if the schedule allows.
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•Failure to pay for services rendered.
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If you are discharged from therapy for any of the above reasons, you will be placed at the bottom of the waiting list and may be rescheduled when an opening becomes available.
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If you have any questions or feel you have a situation that requires special consideration, please feel free to contact our office. By signing below, I agree to the terms of this Attendance Contract and understand the importance of consistent therapy sessions in order to make progress.
Guardian Printed Name

Date

Type Name for Guardian Signature

Your Email (required)

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