Cancel my appointmentPlease complete this form to cancel your appointment. Client Name * First Name Last Name Email * Phone (###) ### #### Date of appointment you are cancelling * Please note that if the notification to cancel is within 24 hours of the appointment 100% fee will apply. MM DD YYYY Cancelling this appointment only Cancelling multiple appointment (provide details in message section of this form) Cancelling all future appointments Name of your clinician * Reason for cancelling Unwell Other commitments Holiday break Discontinuing due to lack of funding Discontinuing due to other reasons Message * Thank you!
