Canceling Surgery

while booking surgery cancelation NNB 2026-10-21

Surgery cancelation checklist

"*" indicates required fields

booking TECH's bv email address*

patient preferred first name*

patient last name*

For your medical safety, our doctors need to be able to reach you on the day of surgery. Please provide me with your personal cell phone number and best email address. [patient needs to verbally confirm]

patient personal cell number*

patient best email here*

patient dob*

I confirm that the patient name, phone number and email are correct and match in hubspot and acuity*

Yes

surgery cancelation checklist (no new booking)

PATIENT SAFETY CHECKLIST
We certainly understand that plans and circumstances can change. We appreciate the trust you've placed in Brinton Vision and want to make sure we understand your decision and address any concerns you may have. Would you mind sharing what's prompting you to reconsider your surgery at this time?

Thank you for sharing that with me. I completely understand, and I appreciate you taking the time to explain. We want you to feel comfortable and confident in your decision. If there's anything we can do to address your concerns, we'd certainly welcome the opportunity. Otherwise, I'm happy to help you with the next steps.

whoever processes the cancellation is responsible to ensure these steps are done

Why do you want to cancel? listen without interrupting. then ask Are there any other reasons you would want to cancel?

direct patient to cancellation request form at brintonvision.com/requests. this gets sent to accounting and doctors who determine if patient should be contacted by doctors.

Did you use financing? if no, skip to next step. if yes: When you first scheduled your surgery and agreed to start the financing, at that point we lose access since it becomes a private loan between you and Alphaeon/CareCredit. For financial security and privacy reasons, we aren't allowed any more visibility to your loan with them. We are happy to push a full refund right away, which can take up to 10 business days to fully travel through the system, and they will honor this, but we have no information on financing charges, interest payments, late payments, and other similar payments which go directly to Alphaeon/CareCredit and not us. These cannot be refunded by us; we have no visibility or access to them anyway. Be sure and make any payments on time until the refund has moved through the system and you have received your funds back so you avoid any charges from the company, or you are welcome to speak directly with them about this. Do you have any questions about how a refund works with financing?

move acuity surgery appointments to the previous sunday

cancel acuity postops associated with that patient; select NO confirmation email to patient

delete future tasks for this patient

set a task to follow up by phone in six months, unless dnc

document in hubspot including reasons described by patient

while booking surgery cancelation NNB 2026-10-21

surgery cancelation checklist (no new booking)

Have you had LASIK or lens implant surgery in the past?