Danina L. Culver, PT
3724 Jefferson, Suite 316
Austin, Tx 78731
512-453-6778
Fax 512-453-6995
Late Cancellation & No Show Policy
Late Cancellation being defined as canceling a scheduled appointment less than 12 hours
before that appointment. Exception: If your child wakes up sick the day of his/her
appointment please notify your therapist by 8:00 a.m.. You will not be charged for that
appointment. Also, please do not bring your child to therapy until they have been free of
fever for 24 hours. Just be sure to call and cancel your appointment. Thank you.
No Show being defined as not showing up for a scheduled appointment and not calling to
cancel said appointment.
Late Cancellation Fee
The amount of $60.00 will be billed directly to you.
No Show Fee
The amount of $95.00 will be billed directly to you.
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Client /Parent Signature
Date