No Show Waiver Request Form

The Dalhousie Physiotherapy Clinic has a cancellation/no show policy for physiotherapy appointments that requires 24 hours notice of cancellation. (See Appointment bookings, fees and forms on our PT Clinic Home Webpage). We understand that sometimes events happen beyond one’s control and such notification cannot be given to one of our staff members. If you have experienced extenuating circumstances preventing required notice to cancel an appointment, please outline your reasons below and we will contact you to discuss further.  

*
*
*
*
 
*
*
*
 
*
 
*