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Reschedule or Cancel an Appointment
LADO HEALING INSTITUTE
Leonard A Lado
MD·
TM
, RPh, ABPN
American Board of Psychiatry and Neurology
Board Certified Psychiatrist
9410 Fountain Medical Court, Suite #200
Bonita Springs, FL 34135
Monday - Friday 9 AM - 5 PM
Phone: 239.948.4325
Click here for MAP or
Driving Direction
Please note that $50 fee may apply if you cancel within 24 hours!
Please fill out this form to cancel your appointment
Appointment Type
*
New Patient
Follow-up Patient
Please indicate the date of your (current scheduled) appointment
+
Did you pay the $50 retainer fee when you have requested this appointment?
Yes
No
Other
Other
Reason for cancellation?
*
Transportation problem
Changed my mind
Found another doctor
Conflict with my schedule
Other
Other
First Name
*
Last Name
*
Phone Number
*
Email Address
*
If you are not the patient. Full name of the person who submits the form?
The submitter relationship to the patient
Self
Mother
Father
Spouse
Child
Grandfather or Grandmother
Grandson or Granddaughter
Nephew or Niece
Adopted Child
Foster Child
Sponsored Dependent
Stepson or Stepdaughter
Ward
Employee
Life Partner
Unknown
Other Relationship
Rules on missed appointments:
You can cancel or reschedule your appointments within 24 hours two ways; 1. cancel or reschedule by using this FORM, which is also available through our website (
ladomd.com
) 2. calling our main office and leaving a message. This fee of $50 and cannot be waived, but it will be applied to your balance at the time of your first visit. Co-pays and deductibles have to be collected at time of visit or we violate the contractual agreement with our insurance companies.
The following link will guide you to the law requirements in physicians expected to collect
missed appointment fees
.
LADO HEALING INSTITUTE
Leonard A Lado
MD·
TM
, RPh, ABPN
American Board of Psychiatry and Neurology
Board Certified Psychiatrist
9410 Fountain Medical Court Suite #200, Bonita Springs, FL 34135 | Monday - Friday 9 AM - 5 PM |