EMG no show forms

[bedrock]

finally my practice is ready to start charging a no show fee to patients who fail to show for their EMG. Does anyone have a practice form they can share with me that is along those lines? I can write something, but if someone that has this written in nice legal language, it would be nice to see an example.

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[Dr. Ice]

We basically just say they will be charged $250 for less than 24 hour cancellation or no show. They fill out a consent for the test during an office visit prior to scheduling and that language is in bold right above the signature line.