Request for No-Show Fee Appeal

When a student fails to show up for an appointment, or cancels without adequate notification, other students who could have been served in a timelier manner must wait longer for necessary services.

If you believe that we have made an error in charging you for a no-show/late cancellation, or feel you deserve special consideration for such a fee, please complete the following form.

Appeals must be submitted within 30 days of appointment date.

Reason for the appeal request:

Reason for the appeal request:

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 an email response at the email address listed above.