Surgery Cancellation Policy Aurora Gonzalez, M.D. & Associates is privileged to provide treatment for our patients. Our staff accommodates the needs of patients to schedule surgery in a timely manner. This requires careful planning and coordination among our office, the surgical facilities, and other medical specialists who may be involved in your care. The cancellation of a scheduled surgery results in failure to serve other patients as well as disruption in schedules for other healthcare professionals and the operating room. Therefore; we respectfully request your cooperation and understanding of the scheduling process and our cancellation policy. Please carefully consider your surgical date before scheduling. Cancellations of surgical procedures made within 10 business days of the scheduled date will be assessed a $250.00 administrative fee. This fee is not billable to insurance or reimbursable. We will require a credit card on file prior to scheduling the surgery. Your information will be kept secure. Upon cancellation, we will charge a $250.00 fee to the card. If you are requesting a refund of your surgery deposit and are within the 10 business day period, you will receive your refund less the cancellation fee. By signing below you are acknowledging that you have read and understand our cancellation policy. Date: Name: Email: Date of Birth: Credit Card Number Expiration Date Δ
