DAVID C. HALL, Ph.D. Clinical Psychologist
715 E. Grand Blvd. Corona, California 92879
800-660-7757 Fax: 775 248 9159
Date: 09/07/2024
The QME appointment will involve 3-4 hours face to face with the patient and will be billed utilizing ML104. We must have your guarantee that the no show charge of $350 will be paid which only minimally offsets the loss in the event of a failure to appear without 48 hours advance notice.
To avoid any misunderstandings, I ask that you sign and return this document to 775 248 9159 as soon as possible and in no event under one week from the appointment date. If I am incorrect as to our understanding in this regard, please notify me immediately. Thank you.