EILEEN C. COMIA, M.D. LLC
35 Jolley Drive Suite no.102 Bloomfield, CT 06002
Tel (860)242-2200 Fax (860)242-2212
POLICY REGARDING MISSED APPOINTMENTS
1. All appointments will be confirmed by our office 3 business days before your
appointment. We will contact you thru the phone numbers we have on-file.
Make sure you have a voicemail set-up for these numbers, that the message
inbox is NOT FULL, and that your cellphone is not blocked.
2. Patient MUST CALL BACK OUR OFFICE TO CONFIRM that you are
keeping the appointment. If you reach our voicemail, please leave a message.
3. To CANCEL OR RESCHEDULE an appointment:
Patient must call the office 24 hours BEFORE the appointment. If
you reach our voicemail, leave your name and number. We will call
you back to confirm that we got your message. If YOU DO NOT
GET A RETURN CALL, WE DID NOT GET YOUR MESSAGE,
and you will be billed for a missed appointment.
Cancellations/rescheduled appointments done LESS THAN 24 hours
to your appointment will be billed as a missed appointment, and
therefore will be your responsibility.
Excused cancellations/rescheduling less than 24 hours are only
accommodated for true emergencies. A written proof must be
submitted for consideration.
4. FEE Schedule for Missed Appointments:
MISSED OFFICE VISIT $40
MISSED PHYSICAL EXAM $60
This is to acknowledge that I am fully aware of the office policy regarding missed
appointments. I will be held personally responsible to pay for the charges if I fail to
abide by the policy. If my account is referred for collection, I agree to pay the legal
and collection expenses including attorney’s fees.
___________________________
(Print Patient’s Name or Legal Guardian)
_____________________________________ __________________
(Signature of Patient or Legal Guardian) (Date)
