Fee Waiver Form for COVID-19 and Other Sudden Illness

Changes to pre-booked appointments must be made before 9am the business day prior to avoid appointment fees. The only exception to this is when unavoidable late cancellations are needed due to the onset of sudden illness, including COVID-19. To apply for a fee waiver, please complete the form below.

Name

First Name

Last Name

What is your reason for cancelling your appointment?

Was it unavoidable that you cancelled with late notice?

Have you considered moving your appointment online?

You are always welcome to move your appointment online at any time. Please contact me separately to arrange this, and only complete this form if an online appointment is not suitable.

Have you re-scheduled your appointment?

Fee waivers will only be accepted if the appointment has already been re-scheduled

Is there anything further you wish to share?