Ann Shippy, MD

Available Forms

Authorization for Use and Disclosure of Protected Health Information Female Intake Form Informed Consent for Telehealth Consultations Insurance Policy Male Intake Form Medicare Private Contract New Patient Cancellation Policy New Patient Letter and Office Policies New Patient Supplement List Newsletter Form Notice of Privacy Practices PATIENT ENROLLMENT AND CONSENT FORM Physician's Records Request List

New Patient Cancellation Policy

New Patient Cancellation Policy

Thank you for scheduling your appointment with Dr. Ann Shippy. We appreciate your patience as it may be several months before we see you or meet you virtually. If Dr. Shippy has a cancellation, we will try to reach you and others to offer an earlier time slot ? however we will fill the appointment to the first patient who confirms with us.

Please note that we do not overbook Dr. Shippy?s schedule. Dr. Shippy sees a limited number of new patients per week, so that she can block out ample time for each patient. New patient appointments are often scheduled up to 6-12 months in advance. When you schedule your appointment this time slot is guaranteed to you (the patient) and no one else.

Confirming your appointment is critical to providing all our patients with timely care and to the efficient operation of our office. We value your time and appreciate you arriving on time for your scheduled appointment.

If you must cancel or reschedule your appointment - please note that we require seven days notice to avoid being charged for the full amount of the visit.

You (the patient) will be charged 100% of the first new patient visit ($4,200) if the appointment is not cancelled within seven days of your scheduled appointment. We require a credit card to schedule all new patient appointments and will charge that card if you do fail to honor this cancellation policy. This fee cannot be charged to an insurance company.

We confirm all appointments approximately 1 month and again one week to 3 days prior to your new patient appointment. This is done strictly as a courtesy, and the responsibility of canceling an appointment remains with the patient.

Your signature below verifies that you have read this policy and are willing to abide by it.

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