WEB Current Patient Cancel Appointment

Appointment Cancellation Form

The completed form will be emailed to a clinician at Gateway. As with all electronic communications, email is inherently insecure. If you want to guarantee the security of your message, please install a secure email service, like Virtru, and email email us at info@gatewaypsychiatric.com.

First Name *This question is required.

Last Name *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required. This question requires a valid number format.

How should we contact you? *This question is required. Email will usually receive a faster reply.

Changing an appointment involves canceling the existing appointment and then finding a new time.

First let's cancel the old appointment.

This is the link to the "Information for Patients" form. The cancellation policy is discussed at the end: https://www.gatewaypsychiatric.com/wp-content/uploads/2014/04/SummaryofInformationforPatientsv3.pdf

When is your existing appointment? *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Who do you have an appointment with? *This question is required.

Patients in active treatment need to always have a future appointment scheduled.

If you cancel this appointment without scheduling a new appointment we will not authorize new prescriptions or refills until you have a next appointment.

Would you like to schedule a new appointment now? *This question is required. If so we will take you to the new appointment page.

WEB Current Patient Cancel Appointment - v3 2017

Cancelling an Appointment