As explained on the Payment & Scheduling Policies page, I am exercising my right to cancel my reservation within a 72 hour time frame of the original booking.

I understand I will be notified of receipt of this cancellation notice at my email address above.

If I have used a credit card, it is my responsibility to contact Dr. Davis’ office by phone during business hours Tuesday thru Thursday to supply my credit card number so that a refund can be processed. For security reasons Dr. Davis’ office does not keep credit card numbers on file.