No-shows ·

How to cut no-shows without being pushy

Seven practical steps for PT, chiropractic and med spa owners to reduce missed appointments, backed by research and practice polls.

Every no-show is a slot you staffed, held and couldn't sell. The good news is that most missed visits aren't patients who meant to skip. In a national survey of outpatient physical therapy clinics, the most common reason staff gave for no-shows was simply that the patient forgot1. That is a fixable problem, and you can fix it without lecturing anyone.

1. Know your number first

Before changing anything, count the no-shows and late cancellations from the last four weeks and divide by the visits that were booked. Clinics in that same survey reported an average no-show rate of 10.4%, with a wide spread from clinic to clinic1. Your own rate is the baseline you will measure every change against.

2. Send more than one reminder

A review of 26 studies found that patients who got text reminders were 25% less likely to no-show than patients who got none (15% compared with 21%)2. The same review found that several reminders worked better than a single one2. A simple pattern is one message two days before the visit and one the morning of. Keep the text to the date, time and location, and leave out the reason for the visit.

Many booking systems include automatic reminders, but they are easy to leave on a single message or switched off. Checking that setting is one of the first things we look at when we review a practice's schedule.

3. Add a human touch where it counts

The same review found that voice reminders appeared to work better than texts2. You don't need to call everyone. Call new patients before their first visit and anyone who has missed before. In a 2025 MGMA poll, practice leaders who held or lowered their no-show rates pointed to a mix of regular digital reminders, automated phone calls and the occasional personal call3.

4. Make rescheduling easier than skipping

Put a reschedule link or a direct phone number in every reminder. When moving an appointment takes ten seconds, a patient who can't make it has an easy alternative to simply not showing up. A cancellation two days out is also a slot you can still fill.

5. Keep a short waitlist

A list of patients who want an earlier time turns a cancellation into a booked visit instead of an empty hour. Text the list as soon as a slot opens and give it to the first person who replies. Reminders alone can't fill a slot that has already been cancelled, which is why we set up reminders and a waitlist to work together when we help a practice with its schedule.

6. Have a policy, and explain it kindly

In a January 2025 MGMA poll, 42% of medical group leaders said their practice charges a no-show fee, and practices with a fee were more likely to report fewer no-shows in 2024 (25% compared with 16%)4. It is a self-reported poll, so treat it as a signal rather than proof.

A fee isn't the only option. Some practices ask for a card on file only after a second missed visit. Whatever you choose, put it in writing, mention it when the visit is booked and apply it the same way for everyone. Keep in mind that no-show fees are not allowed for Medicaid visits3.

7. Reach out the same day

When someone misses, call or text that afternoon: "We missed you today. Would you like to grab a new time?" No guilt, just an easy way back. It keeps the patient's care on track and puts the visit back on your schedule.

What are no-shows costing you?

Our free missed-appointment calculator gives you a yearly figure in under a minute. If you would rather see the real number from your own schedule, that is part of what our Revenue Audit measures, along with the other places your schedule may be losing money.

Want to know what this is costing your practice? A Revenue Audit measures it from your own schedule.

Book a revenue audit

Sources

  1. Bokinskie J, Johnson P, Mahoney T. Patient No-show for Outpatient Physical Therapy: A National Survey. University of Nevada, Las Vegas, 2015.
  2. Robotham D, Satkunanathan S, Reynolds J, Stahl D, Wykes T. Using digital notifications to improve attendance in clinic: systematic review and meta-analysis. BMJ Open, 2016.
  3. MGMA Stat. Patient no-shows in 2025: What's changing and what to do about it. August 14, 2025.
  4. MGMA Stat. No-show fees in medical practices on the rise to balance bumpy attendance rates. January 8, 2025.

Written by Emmet Alexander, founder of Alexander and Company. General business information, not legal, billing or medical advice.

Back to all practice tips