Texas Tech University

Missed Appointment Fee Appeal Form

When an appointment is scheduled, that time has been set aside for you. When it is missed, that time cannot be used to treat another patient. If you are unable to keep your appointment, we ask for advanced notice of cancellation to allow us time to schedule other patients who need to be seen in that appointment slot. If you believe that we have made an error in charging you a Missed Appointment fee or feel that you deserve special consideration for your fee, please complete the following form. Appeals must be submitted in-person or via email within 14 calendar days of the date the fee was applied to your Student Business Services account. Appeals will be considered on a case-by-case basis. Failure to receive an appointment reminder will not be considered as grounds for an appeal as appointment reminders are a courtesy and students are responsible for knowing their appointment time.

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If you have any supporting documentation to upload you will be able to do so after you submit this form.

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Student Health Services