Sleep Testing Agreement

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Sleep Well Diagnostic Center, Inc.
1314 Oak St.
Melbourne, FL 32901
Phone (321) 727-7992 Fax (321) 727-7664

Sleep Lab Cancellation

Once your sleep study is scheduled you MUST give our of8ice at least 24 hours’ notice before cancelling or rescheduling your test. You will be contacted 1-2 days prior to your appointment for con8irmation. Please make sure our office has your updated contact information so that you may be reached.


*If you do not show up for your in lab sleep testing appointment or do not give us the prior notice, this will result in a $200 fee.


*If you do not show up to pick up home sleep testing equipment as scheduled or do not give us the prior notice required, this will result in a $65 fee.


-A $100 deposit will be required for home sleep test


-Testing equipment needs to be returned the following day or you will be charged a fee of $100/ day.


-If testing equipment is not returned after 7 days you will be charged for cost of equipment.


By signing below, I agree that I have received a copy of the sleep lab cancellation policy. I understand that I must give a 24 hour notice of cancellation or rescheduling of my sleep study. I understand that failing to provide 24 hour notice will result in a a cancellation fee as outlined above.