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CORTLAND COUNTY Mental Health Clinic 7 CLAYTON AVENUE CORTLAND NEW YORK 13045 PHONE: (607) 758-6100 FAX: (607) 758-6116 While the Cortland County Mental Health Clinic very much wants to be of help to you, we can only provide services to families and individuals who attend regularly or call ahead if an appointment must be cancelled. When patients consistently fail to show for appointments or cancel at the last minute, it becomes a serious problem for all involved. We do not schedule other activities during scheduled appointment times. We, therefore, have a clear policy on what we call “no show” or “late cancellations” (cancelling an appointment with less than 24 hour notice). It is as follows: If you have “No Showed” or “Late Cancelled” an appointment with your clinician or the medical staff, you will have to wait a week to be rescheduled. If you miss three appointments within a three month period, you may receive a letter indicating that your case is being closed because of failure to attend. That letter will contain an offer to provide a referral should you wish to pursue services elsewhere. A pattern of coming late to appointments may be another basis for termination. Failure to attend therapy appointments will also jeopardize any medication appointments you may have. If you have any questions or concerns regarding this policy, please discuss them with your therapist. You should also bring up any reservations you might have about attending therapy or issues that might get in the way of you or your family coming in for appointments. Please indicate that you have read and agreed to this policy by signing below. Thank you. Signature Date