Kevkev ghosted the clinic riiiiight up until he realized that oh noes I need to show my ass up for my tiddy skittles! Or maybe what he got approved on for the bolt-ons was starting the process and the visit was to get his letter.
They do this with testosterone to keep you from skipping your Hb checks--which means yes, this is a problem, given you can set that up so just it's a swing by a Quest or LabCorp office for a routine blood draw and give you a quic message letting you know that you're clear & the script's at your pharmacy or if somebody needs to see your ass outside of the phlebotomist. This is what happens when a group makes a habit of fucking off on entirely necessary appointments. This is one of those things the trooncult can't REEE away, only try to dodge by keeping shady 'clinics' like Dr. Nick's Discount Tranny Emporium running and going to sketch dealers.
Of course, the prospect that Kev would probably/inevitably return--after all, clinic didn't get word he was going off to haunt somebody else's nightmares--easily could have been a factor in deciding to join the annual shuffle. Either way, however, it was just serendipity that Kev had such good timing.