How to reduce no-shows in your clinic, and keep goodwill

Appointment reminders: SMS, email and timing

Forgetting is one of the main reasons people miss appointments, and it is the easiest one to fix.

A Cochrane review of eight trials found that text message reminders improved attendance compared with no reminder or a postal one, and worked about as well as a phone call while costing less per attendance. The evidence was rated low to moderate quality, but it is the best there is.

A reminder schedule that suits most practices

• At booking: an email confirmation with the date, time, address or video link, what to bring, and your cancellation policy in one line.
• Two or three days before a first appointment: an email with parking, directions or how to join online, and who they will see.
• Before your notice period starts: a text with a link to confirm, cancel or rebook. If your policy asks for 48 hours' notice, send it at around 72 hours, not 24. A reminder that arrives after the free cancellation window has closed feels like a trap.

Make cancelling easy. A client who can cancel in ten seconds gives you a slot you can refill; one who has to phone during working hours may simply not turn up.

Keep reminders discreet

Texts appear on lock screens. For therapy, psychology and some medical appointments, leave out the type of service: "Reminder: your appointment with Sam on Tuesday at 3pm" is enough. Our guide to GDPR for private practices covers the data side.

First appointments need more care than follow-ups

A new client has no relationship with you yet, so there is less holding them to the booking.

A first appointment is often booked on a hard day, sometimes weeks ahead, by someone who is nervous about coming. By the time it arrives, the pain may have eased or the nerve may have gone. Booking software reflects this: Jane, for example, lets you set a payment rule for first-time appointments only.

For first appointments

• Keep the wait between booking and appointment short where you can.
• Offer a short phone or video call first. In therapy this is common: BACP notes that many therapists offer a free introductory session.
• Consider a card on file or a deposit for first visits only, explained plainly at booking.

For follow-ups

• Rebook before the client leaves, ideally into a regular day and time. Weekly therapy works well as a standing slot.
• For physio, osteopathy, chiropractic and other courses of treatment, agree the plan in the first session so each follow-up has a purpose the patient understands.
• Notice patterns. Two late cancellations in a row are worth a gentle conversation, which often tells you more than a fee would.

Deposits, card on file and what UK consumer law allows

Asking for some payment up front reduces no-shows, but consumer law limits how much you can keep when someone cancels. This is general information, not legal advice.

Your options, lightest first

• No payment at booking: the least friction and the most risk.
• Card on file: charged only if you apply a late cancellation or no-show fee. Jane, for example, offers this as a booking payment rule.
• Deposit: a part-payment taken at booking and deducted from the fee.
• Full prepayment: common for sports massage and some aesthetics treatments, less comfortable for therapy (see BACP's view below).

Always take card details through your booking or payment system, never by email or on paper, and tell the client at booking exactly when the card could be charged.

The fairness test

Under the Consumer Rights Act 2015, an unfair term in a consumer contract isn't binding on the consumer, and Schedule 2 lists terms that may be unfair, including ones that make a consumer who cancels, or fails to keep their side of the deal, pay a disproportionately high sum in compensation. The CMA's guidance for businesses puts it in practical terms:

• A cancellation fee must not be excessive and should reflect steps you can take to reduce your losses, such as offering the slot to someone else.
• Non-refundable amounts are more likely to be fair when they reflect a genuine estimate of what you will lose directly because of the cancellation.
• A deposit you keep in full should be a small percentage of the price, and clients should know when it becomes non-refundable.

So charging for a session you could not refill is usually defensible; charging the full fee when you filled it from your waitlist is much harder to justify.

Bookings made online or by phone

When a client books online or by phone, the Consumer Contracts Regulations 2013 usually give them 14 days to cancel a contract for services. Their health exclusions cover NHS-type supply of medicines and products, not a private session. If the appointment falls inside those 14 days, the client has to ask for the service to start early, and if they then cancel, they pay only for what you have provided. How that sits with a late cancellation fee is not straightforward, so take advice before charging for an appointment booked in the previous fortnight.

What BACP and the HCPC say about charging for missed sessions

Neither body bans charging for missed sessions. What they expect is that clients know the terms before they start.

BACP

BACP's July 2026 piece on fees, from its client ethics team, says fees should be discussed clearly and set out in a written contract, and that clients should know what is payable if they miss or cancel a session. It describes notice periods of 24 hours, 48 hours or a week as usual. It raises concerns about charging for cancellations however much notice is given, and warns that pre-paying for blocks of sessions can benefit the therapist more than the client. BACP also tells the public to check charges for missed appointments and holidays before starting, so expect clients to ask.

BACP's updated Ethical Framework becomes mandatory on 3 November 2026, so check the current wording when you review your contract.

HCPC

The HCPC's standards of conduct, performance and ethics don't mention fees or cancellation charges. The relevant standards are general ones: give service users the information they want or need in a way they can understand, and make sure your promotional material is accurate. In practice: clear terms, given in advance, and the same on your website, booking page and paperwork.

Insured patients

If you see patients through Bupa, AXA or another insurer, check your recognition terms before charging a missed appointment fee. Make sure the patient knows at booking that a late cancellation charge would be theirs to pay. Our guide to getting recognised by Bupa and AXA covers recognition itself.

Writing a cancellation policy for therapists and clinics

A good policy is short, written in plain English, shown before booking, and applied the same way to everyone.

Setting a late cancellation fee: private practice basics

• Notice period: 24 or 48 hours is common.
• Fee: part of the session fee for late cancellations, or the full fee for very late cancellations and no-shows. Whatever you choose should reflect what you lose, which is less if you can refill the slot.
• Exceptions: say you will use discretion for illness, emergencies and bereavement.
• When you cancel: say what happens if you are the one who cancels. A term that lets you keep a client's money when they cancel, without them getting an equivalent amount when you do, is on the Consumer Rights Act's list of terms that may be unfair.
• Holidays and breaks: for ongoing therapy, say how much notice clients should give for holidays and whether their regular slot is held.

A wording framework you can adapt

Put the policy on your fees page, in your booking confirmation, and in your client contract or terms. If a client first sees it on an invoice, it will feel unfair, whatever it says. Our guide to how much to charge per session covers the fees themselves.

Waitlists and short-notice fills

Every slot you refill is income recovered, and a filled slot is one you have no loss to charge for.

• Keep a list of people who want an earlier slot. Ask new clients at booking whether they would take a cancellation, and which days and times suit them.
• Send one message to several people. "A 2pm slot has come up tomorrow, first to reply gets it" fills faster than calling one person at a time.
• Keep online booking open close to the day. When a client cancels through a link, the slot can go straight back on your booking page.
• Use your software's waitlist if it has one. Some systems include waiting lists on their higher plans, such as Jane's Thrive plan and TM3's Better plan.

Short-notice fills are harder in therapy, where most clients want a regular time. A waiting list for new clients still helps: when someone finishes, you can offer their slot straight away. In physio, osteopathy and sports massage, where someone in pain may well take tomorrow at 2pm, a short-notice list is worth setting up first.

How practice management software helps

Almost everything in this guide can be automated, which is why your booking system is the first thing to set up properly.

• Automated email and SMS reminders with your own timing and wording. SMS is usually charged per message: Cliniko charges 10 cents a message and Zanda 9p, for example.
• Online cancellation with a minimum notice period. Cliniko, for example, lets you stop clients cancelling through the link once the notice window has passed.
• Payment rules at booking, such as a card on file, a deposit or full payment.
• Attendance records, so you can spot patterns.

Our comparison of practice management software in the UK covers Cliniko, WriteUpp, Jane, Semble, Zanda and TM3, with prices checked in October 2026. Whichever you use, test the reminder and cancellation flow on your own phone first.