What to do about “no-shows” and cancellations

Clients who “no-show” or “late-cancel” their appointments can be a real problem for private practitioners.  Many who are new to private practice are afraid to enforce any cancellation policies for fear of alienating clients.

When you set aside time in your schedule to meet with a client, that time represents a commitment.  The commitment on your part is that you will be there with your sleeves rolled up to do your best work for and with your client.  The commitment on their part is that they will be there, and they will pay you for your hard work.

When a client fails their appointment or calls that day to cancel or reschedule their appointment, they are breaking their commitment to you and to their treatment.  It is a therapeutic issue.  It is also a financial issue.

Most insurance companies will not reimburse practitioners for failed appointments, so it is very important that you establish your “no-show” and cancellation policies and then inform and enforce them with your clients.  This is most easily done within the content of your Outpatient Services Agreement (that your client signs before the first session).  It’s also a helpful reminder to clients if you have that policy printed (in some form) on your appointment cards.

In my practice, I require a minimum of 24 hour notice for cancellations.  If a client “no-shows” or cancels within 24 hours of their appointment, they are financially responsible for the fee for that session.  If i charge $100 per session, the failed appointment fee is $100.  I don’t discount my service fee just because the client chooses not to attend.

Of course, there will be times when you may bend your rules.  In my practice, if the client has a critical emergency or illness I generally do not charge them.  If this becomes a repeated issue, we discuss this in the course of treatment and proceed from there.

One example of this is a client who repeatedly cancels appointments because he has panic attacks.  It is actually counter-therapeutic for me to play into the avoidance by not charging because he feels too ill to come in.  We’ve discussed this and he understands the fee will not be waived.

In my practice, clients are expected to mail or call in their payment for the missed appointment before the next appointment can be made.  If it is a longstanding client with whom I’ve not had attendance issues, I will allow them to pay me at the next session.

You’ll find the more clear and consistent you are with your policy, the more accepting and respectful clients are of that policy.  If you are respectful of your clients’ time (you run on time and you don’t cancel a lot of appointments) you’ll find that clients are much more likely to be respectful of your time.

If they get angry, that’s okay.  It can be grist for the mill of therapy.  If they leave you over your policy, don’t despair — they likely would have become repeat offenders;  better to cut your losses early in that game.

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  1. Dianne Baer /Reply

    This sounds helpful! I’m going to give it a try and see how it helps!

  2. Maggie /Reply

    Thank you! This is a clear, straight forward, unbiased, and thus useful approach to handle this issue.

    1. legge /Reply

      @ Maggie – You are very welcome Maggie!

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