WESTERN MEDICAL ASSESSMENTS TERMS AND CONDITIONS

Cancellations will be accepted until 12:00 noon, 15 days prior to appeal without incurring late cancellation fees. Should you cancel after that time, or should the Claimant not attend appointment/s, there will be a ‘no-show’ fee as per the Appointment Confirmation Letter (plus any additional fee the specialist feels necessary for review of documentation).

A timely start is required for all appeal dates with specialists. If the time of the testimony is likely to be delayed, the specialist may not be able to give testimony due to other commitments, in which case the appeal will be treated as a ‘no-show’/late cancellation incurring a fee plus any fee the specialist feels is adequate to compensate him for review of documentation.

In the unlikely event that the appeal cancels or the claimant fails to attend as scheduled after the confirmation deadline date, Saskatchewan Government Insurance will be invoiced for a ‘no-show’/late cancellation fee plus any additional fee the specialist feels necessary for review of documentation. If the request is made within the 15 day confirmation deadline date due to the appeal being cancelled or the claimant failing to attend as scheduled, the ‘no-show’/late cancellation fee plus any additional fee the specialist feels necessary for review of documentation will apply.

We enclose the “Agreement to Pay Fees” and the “Terms and Conditions” forms that we would ask you to read and sign where indicated, and return to us along with the deposit no later than the cancellation deadline date provided on the Appeal Confirmation Letter.

This retainer/deposit will be refunded to the payer, minus an administrative fee, should the need for the services fall through and the cancellation deadline has been exceeded.

All medical documentation is to be forwarded to our office at least 21 days prior to the appeal to give the specialist sufficient time to review the documentation. This is to avoid a potential cancellation of appeal for which you would be financially liable.

_________________________________ ______________________________

SIGNATUREDATE