Cancellation
The cancellation is handled and the official document is filled in according to the cancellation
protocoll!
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Email *
Type of the service *
Required
Please select the institute where you wish to cancel the pre-booked appointment: *
Full name of child *
Reason of the cancellation *
Name of therapist *
The date of the cancelled appointment:
MM
/
DD
/
YYYY
Time
:
Type of the cancelled early intervention service: *
Required
Submit
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