Date: 07/27/2024

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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.

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