CANCELLATION POLICY FORM

Speech Journey Therapy Guidelines

  • Sessions

  • • Sessions are usually one hour in length, which includes any time necessary for parent consultation, scheduling and billing issues.

  • Commitment/Scheduling

  • • Your treatment and care are of the utmost importance to me and I value nurturing a mutually respectful relationship with you and your family. A strong commitment to the process is essential for steady progress.
  • • Once a session is scheduled, 24-hour notice is required for any cancellation or postponements. Clients will be charged in full for any session cancelled less than 24-hours in advance. I will do my best to accommodate a makeup session. However, if we cannot find a mutually desirable time to reconvene within a one-week period, it will be considered a cancellation and the full session fee will be charged.
  • • Occasionally, I may ask if you can move a session time. Please know if I am doing so, it is probably because I am trying to accommodate another client and that your scheduled session comes first.

  • Billing

  • • Payments may be made via cash or check (made out to “Speech Journey”). There will be a $35 fee charged for any returned checks.
  • • Insurance reimbursement may be possible. You will be provided with receipts of payment to submit to your insurance company. It is your responsibility to inquire about your plan’s benefits. I will provide whatever assistance I can in helping you receive the benefits to which you are entitled, however, you (not your insurance company) are responsible for full payment of my fees.


  • Your signature below indicates that you have read this agreement and agree to its terms.