SFSU Student Health Services

SFSU Student Health Services

Petition for Waiver of No-Show Fee / Late Cancellation Fee

Policy

Students who need to cancel their appointment should do so online at myHealth (health.sfsu.edu) or by phoning the SHS cancellation line at least 24 hours in advance of their scheduled appointment.

Please include your First Name, Last Name, Student ID number, and the date and time of the appointment you wish to cancel. Your Message will be date and time stamped.

Telephone # for Appt Cancellations:-

Telephone 415-338-1251

Press #1 on the keypad.

No Show Fee

“No shows” and “Late Cancellations” waste the Student Health Service’s limited resources and adversely affect the care provided to SFSU Students.

Due to the high demand for medical appointments and the number of “no shows” and late cancellations the SFSU Student Health Service has had to institute a "no show" policy and “no show / late cancellation” fee.

All “no shows” and late cancellations will be billed $20.00.

Petitions for a “No Show / Late Cancellation Fee Waiver” will ONLY be approved for significant bona-fide reasons.

Petitions for a “No Show / Late Cancellation Fee Waiver” will only be considered if received within one month of your missed appointment.

Petition Process

If you have a significant bona-fide reason for missing your appointment

Please send the completed “No Show / Late Cancellation Fee Waiver Form” (Word format) to the SHS via:-

Your SFSU email address to the

With the following Subject Line - No Show Fee Petition

OR

The US Mail to the SHS address listed below.

Please be advised that it may take 5 working days after receipt to process your petition.The reply will be forwarded to your SFSU e-mail address.

Director’s Office

San FranciscoStateUniversity
StudentHealthCenter
1600 Holloway Ave.
San Francisco, CA94132

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PETITION TO WAIVE SFSU

SHS NO-SHOW FEE / LATE CANCELLATION FEE

Please Complete This Form and Send it Via E-mail or US Mail

To The Director’s Office SHS

Please TAB between fields – note date and time must be in correct format.

Please see detailed instructions for e-mailing or mailing above

Explanation for “No-Show / Late Cancellation of SHS appointment :-

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