Patient No-Show Agreement

Thank you for choosing Blue Ridge Medical Center for your healthcare needs. At our center, you can expect caring professionals to provide you with the highest quality care.
Patients at our center have rights and responsibilities. These lists are part of the registration packet and are posted in various places in the building.

A very important patient responsibility is to keep your appointment and to arrive on time. This helps us to give you good care and keeps access open for others in the community who also need to be seen.

Please take some time to read through the following statements and indicate that you understand them. If you have any questions, please ask at the front desk. We will be glad to explain further.

Thanks again!

In order to acknowledge our No-Show policy please either:

  • Fill out and submit the form below.
  • Or save and print the pdf form to fill out before bringing it into or mailing it to our office.

No-Show Agreement Online Form

     The * means it is required.

No-Show Agreement Downloadable Form