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<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Appointment Cancellation Policy</title>
    <style>
        body {
            font-family: Arial, sans-serif;
            line-height: 1.6;
            margin: 0;
            padding: 0;
            width: 100%;
        }
        .container {
            width: 100%;
            padding: 20px;
            box-sizing: border-box;
        }
        h1, h2 {
            color: #333;
        }
        ul {
            padding-left: 20px;
        }
        input[type="text"], input[type="tel"] {
            width: 100%;
            padding: 8px;
            margin: 5px 0 15px;
            display: inline-block;
            border: 1px solid #ccc;
            box-sizing: border-box;
        }
        input[type="submit"] {
            background-color: #4CAF50;
            color: white;
            padding: 14px 20px;
            margin: 8px 0;
            border: none;
            cursor: pointer;
            width: 100%;
        }
        input[type="submit"]:hover {
            opacity: 0.8;
        }
    </style>
</head>
<body>
    <div class="container">
        <form action="#" method="post">
            <h1>Appointment Cancellations</h1>

            <p>Please provide at least 24 hours' notice if you need to cancel or reschedule an appointment. This allows us to offer your time slot to other patients.</p>

            <h2>Fees</h2>
            <ul>
                <li>Late Cancellation (&lt;24 hours): $30 fee</li>
                <li>No Show: $30 fee</li>
            </ul>

            <h2>Dismissal</h2>
            <p>After 3 missed sessions without notice, you may be dismissed from counseling to ensure we can provide care to all patients.</p>

            <h2>Reminders</h2>
            <p>We offer text reminders as a courtesy, but you are responsible for remembering your appointments regardless of receiving a reminder.</p>

            <label for="phone">Please confirm your phone number if you'd like text reminders:</label>
            <input type="tel" id="phone" name="phone" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" placeholder="123-456-7890" required>

            <h2>Agreement</h2>
            <p>I have read and understand the cancellation policy and fees.</p>

            <label for="clientSignature">Client Signature:</label>
            <input type="text" id="clientSignature" name="clientSignature" required>

            <label for="date">Date:</label>
            <input type="date" id="date" name="date" required>

            <h2>Arrival Time</h2>
            <p>Please arrive on time for appointments. Arriving >15 minutes late may require rescheduling.</p>

            <p><strong>We appreciate your cooperation with our policies. Thank you!</strong></p>

            <input type="submit" value="I Agree to the Cancellation Policy">
        </form>
    </div>
</body>
</html>