How to Reduce No Shows in Your Private Practice: Winning the No-Show Battle: Boundaries and Alternatives Rule!

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If you’ve been in practice for a while, you’ve learned to recognize those appointment spots that always seem to end up cancelled or worse, no-showed. We all have them. It is estimated that the average no-show rate can be from 10-20% or more. The ups and downs can make you crazy and keep you on edge.

What’s a practitioner to do?

The good news is, there are things you can do to reduce late cancels/no-shows and keep your 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? By being proactive. You need to understand why your clients no-show.

What can you do to make it more likely they will keep their appointments? Set boundaries and offer alternatives.

Setting Boundaries & Expectations

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 so that they understand their responsibilities as a client.

Your specific approach will vary but here are some common ways to set boundaries and expectations with your clients regarding attendance:

No-Show/Late Cancel Policy - Have a clear no-show/late cancel policy. Many therapists set a no-show/late cancel fee. These fees are not covered by insurance. Make sure your client understands and signs the policy.

Credit Card On File – Many therapists require a credit card on file so that things like co-pays 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.)

Reminder Calls – You or your designee can call and remind clients of appointments. The upside is they are reminded and can cancel with you ahead of time if need be. The downside is that calling every client day after day is very time consuming.

Alternatives and Options

One of the biggest reasons clients no-show is inconvenience. 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-shows 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. They may incur late cancel/no show fees.

What if you could offer your clients an alternative to having to late cancel or no-show? What if they could keep their appointment after all and get the help they need? Enter telehealth.


Telehealth offers you and your clients a convenient and cost-effective way to still be seen and avoid those missed appointments. When conflicts arise, you can offer your client the option of doing a session online at the same time or even at 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.

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.

Take a look at your practice. Take a look at the patterns. What do you need? What do your clients need? Telehealth just might be able to help you meet those needs making it a win-win for your practice and for your client.  If you decide to offer teletherapy in your practice make sure that you choose HIPAA compliant video conferencing platform such as TheraPlatform.

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