How to reduce no shows in your private practice

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No shows and cancellations are a common, long-standing issue for therapists in solo and group practices and can interfere with client care as well as lead to loss of anticipated revenue. A no-show occurs when a client fails to attend a scheduled therapy appointment without notifying the provider.

If you’ve been in practice for a while, you’ve learned to recognize patterns in your no shows and cancellations. We all have them. It is estimated that the average no-show appointment rate can be from 10-20% or more. The ups and downs of no shows and cancellations can make you crazy and keep you on edge.


Why clients cancel appointments

The most common reasons for no shows and cancellations include miscommunication, forgetting about the appointment, scheduling conflicts and inconvenience, which is a big one.

Whether it is simply not wanting to drive to an appointment or a last-minute issue, the bottom line is sometimes keeping an appointment is just inconvenient.

Some of the more common reasons for no-show appointments are:
  • An unexpected work schedule conflict
  • An unexpected family issue such as a child
  • Personal illness
  • Car trouble or not wanting to make the drive
  • Not wanting to have an extended wait time to be seen


When these situations arise, clients often feel they have no choice but to cancel late or worse, no-show. They may get frustrated and stop coming but there are solutions.

How to reduce no shows and cancellations

The good news is, there are things you can do to reduce cancellations and no shows and keep your private therapy practice running smoothly. Savvy therapists recognize the patterns of their practices and are proactive in minimizing no shows and filling those predictable gaps. How are they doing that?

See a few ideas for reducing cancellations and no shows below:

Self-serve scheduling: Empower your clients to set their appointments with an online scheduling widget based on therapist availability. Self-scheduling not only reduces no-shows but reduces the administrative burden on busy staffers and therapists. Also, if you’re a therapist or group practice that still schedules your appointments via phone, providing a tech-enabled option leads to less time on hold and an improved client experience. 

Automated appointment reminders: Text or email reminders are a great way to remind clients of upcoming appointments or provide options for them to reschedule in advance should a conflict arise. Text reminders can also be customized in terms of content and frequency for a personalized experience.

Having a credit card on file: Many therapists require a credit card on file so that things like copays and missed appointment fees can be collected at the time of the appointment. You will need to make sure you have written consent from the client to charge the card for specific items only. (This may vary by your location.) You can also collect payment at the time of scheduling improving the likelihood that the appointment will be attended and paid for.

Offering telehealth as an option: Telehealth offers you and your clients a convenient and cost-effective way to avoid missed appointments. When conflicts arise, you can offer your client the option of doing a session online at the same time or even at a later time.

You can offer telehealth as a routine scheduling option for appropriate clients. Offering telehealth lets your client know that you are sensitive to their needs and that they have choices about how they want to engage with you. And, here’s a bonus: the no-show rate for telehealth is estimated to be less than 5%.

Telehealth offers clients the flexibility to schedule when and how they need. A post-lunchtime appointment becomes an option when the client can remain at work, see you virtually and return to their work all in a smooth transition. When clients can engage you easily and without a lot of inconvenience, they are much more likely to schedule and keep appointments.


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Some other ways you can use telehealth to keep your schedule stable:
  • Offer existing clients the option of routine telehealth sessions
  • Designate certain appointment times as telehealth only and schedule accordingly
  • Increase availability of telehealth during those slow times of year (eg.,around holidays, summer breaks)
  • Make sure your referral sources know you offer telehealth for some clients


Of course, telehealth is not for every client, nor is it a “quick fix” for no-shows and scheduling issues. The decision to offer telehealth takes thoughtful planning.

Used judiciously and when clinically appropriate, telehealth can help your clients to be more engaged in therapy and help you to avoid the extreme ups and downs of scheduling.

Setting boundaries with clear policies

You set aside time just for your clients. You cannot easily fill a no-show spot at the last minute. Your time is valuable. As much as we love our clients, it is important to set boundaries with them.

One of the ways to achieve this outcome is through a no show appointment and cancellation policy. Sharing this information in advance of your sessions helps clients understand their responsibilities in the therapeutic process as well as protects your business. Many therapists include a no-show/late cancellation fee which are not covered by insurance. Make sure your client understands and signs the policy.

Another option is having a termination policy on file should the need arise. Moving thoughtfully but swiftly can help your client find a provider more suited to their needs in terms of location or even approach and help practitioners attend to clients with a firmer therapeutic commitment.


Owning and running a therapy practice can be a rewarding experience if managed appropriately. TheraPlatform, an EHR, practice management and teletherapy tool for therapists can help with reducing no shows and cancellations. They offer a 30-day trial with no credit card required. Cancel anytime.

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