Please Be Advised - Physical Therapy

Physical Therapy
Massage Therapy
Balance Rehab
Vestibular Rehab
Laser Therapy
MPS Pain Therapy
Please Be Advised
We reserve the right to charge you $30.00 fee, for any cancellations without 24 hours
notice, and/or no call no show appointments. Please sign below to state you do
understand cancellation/no call no show fee.
Le informamos que se cobraran $30.00 a quellos pacientes que cancelen su cita sin
avisar 24 horas de anticipacion o que no se presenten a la cita. Por favor firma abajo,
para confirmar que entiendes y aceptas este aviso.
Thank you / Gracias,
One On One Rehab, Inc.
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Patient Signature
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Print name
4968 Royal Gulf Circle
Fort Myers, FL 33966
Tel: (239) 275-4411
Fax: (239) 2754-6408
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www.oneononerehab.com E-mail [email protected]