Cancellation/Late Policy Form

Payment Policy

All Co-payments and any past due balances are due at the time of visit. If you receive a bill and would like to make payments, this will need to be arranged with AHS billing at 773-935-4700 prior to your next visit.

Cancellation Policy

As our practice continues to grow, we have updated our cancellation policy in order to better serve our patients. Your appointment time is reserved especially for you. Please call 773-224-9600 at least 24 hours before your scheduled appointment if you will be unable to keep your appointment. This allows Dr. Kushner to offer that appointment to another patient who needs medical care. Conversely, the situation may arise when another patient fails to cancel and we are unable to schedule you for a visit, due to seemingly "full" calendar for the day. If you do not cancel your appointment at least 24 hours in advance, you will be charged a no-show or late cancellation fee of $100. This fee is not covered by insurance.

We understand that life gets busy. However, a pattern of missed appointments without proper notice does not show mutual consideration. Patients who fail to provide advanced cancellation for three appointments in the span of one year may be subject to dismissal from the practice.

Late Arrival Policy

We know that delays can happen when you are trying to get to your appointment. However, we must try to keep the other patients and doctors on time. If you arrive 15 minutes past your scheduled time, we may have to reschedule your appointment.

I have read and acknowledged your payment, cancellation and late policies.

Contact Us

Office Hours

9:00 am - 5:00 pm
9:00 am - 5:00 pm
9:00 am - 5:00 pm
9:00 am - 5:00 pm
9:00 am - 5:00 pm
9:00 am - 12:00 pm 1 - 2 per month