ACD VRI: Request VRI cancellation

IMPORTANT!

If you are cancelling an assignment within the next two (2) business days, you must call our office to confirm receipt of the cancellation. Please be advised ACD requires two (2) full business days (48 hours) notice on all cancellations. Less than two (2) business days notice will result in charges for original time scheduled. Please complete one form for each cancellation.

Office: (954) 431 6505

Emergency line (after 5:00PM): (954) 347-5749

Please note: fields marked with * are required.

VRI Cancellation Request Form

Date(s) for appointment* (mm/dd/yy)	A value is required.
*Start time:**	A value is required. Please remember to specify AM or PM
*End Time:**	A value is required. Please remember to specify AM or PM
Reason for appointment*	A value is required.
Deaf client name (full name)*	A value is required.
Name of requester (person who made the original appointment*	A value is required.
Cancellation requsted by (your name)*	A value is required.
Company name*	A value is required.
Requester VP user ID*	A value is required.
Phone*	A value is required.
email*	A value is required.Invalid email format.