Policy for Cancellation of a Procedure
I, _________________________________, have been scheduled for a procedure with John J. Basile, M.D., or Sunil V. Patel, M.D. I understand that an advance notice of 48 hours is required for cancellation in order to avoid assessment of a $100.00 fee. I agree to pay this fee, and understand that it is not the responsibility of my insurance company.
JOHN J. BASILE, MD, PC
SUNIL V. PATEL, MD
3020 Hamaker Court, Suite B-111
Fairfax, Virginia 22031-2220
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