I'm not sure if the policy is 24 or 48 hours notice but one time I went when I was having some crazy random allergy attack and could barely open my eyes, souldn't stop sneezing or blowing my nose etc..... I woke up like this and normally would have canceled but didn't want to have to pay the missed appointment fee. T said that I should have stayed home and that she wouldn't have charged me because I had a good reason. So it sounds like it's kind of up to her discretion. I know that she would not let me off the hook if I clearly just didn't want to go because we will always find stuff to talk about.