di? — ColumbiaDoctors The Physicians and Surgeons of Columbia University www.ColumbiaDoctcrs.crg Columbia Rehabilitation Medicine Appointment Policy Welcome to our practice! Rehabilitation and Regenerative Medic-in. 180 Fort Washington Ave., Ilarkness Pavilion, Suite 199 New York NY 70032 We value your time, and therefore work hard to keep our practice efficient and well-organized. In order to ensure that patients are seen as promptly as possible, we are informing you of our appointment policy. LATE APPOINTMENTS: Patients should arrive at least 15 minutes prior to their appointment time in order to ensure proper time to complete paperwork. We understand that occasionally traffic or other considerations may prevent on-time arrival, however patients who arrive more than 20 minutes late will be asked to reschedule their appointment. MISSED APPOINTMENTS: We understand that things come up in life, and occasionally you may need to cancel an appointment. If you need to cancel, please do so as early as possible. Patients who fail to show up for an appointment, or cancel or reschedule an appointment within 24 hours of their scheduled appointment (including rescheduling due to arriving late to an appointment) will be considered "no- shows." Patients with two or more no-shows will be discharged from the practice. We will, of course, provide copies of any medical records on request, and can provide suggestions regarding other practice options in the area for any patients discharged from our practice. I understand the Columbia Rehabilitation Medicine Appointment Policy. Signature: Printed Name: ,1- —C-Ficr2E1 EPSrc-iri Date: PAViros)Ci7 EFTA00313688