Missed chiropractic appointments and juggling an always-changing patient schedule can be frustrating, annoying … and financially troubling. Not only is it difficult for DCs and clinic staff to maintain a steady work flow, it also negatively affects patient progress and your monthly revenue.

Managing Missed Chiropractic Appointments

Preventing and managing no-shows is a challenge. How do you reduce your rate of missed appointments? What are ways to handle them properly, and how can you boost attendance?

With customizable chiropractic management software, clearly defined policies and a little marketing creativity, you can get that no-show rate down.

Patient Reminders: The Basics

A good way to start decreasing appointment no-shows is by investing in practice management software specifically designed for chiropractors, with built-in systems that help send patient reminders before appointments. That, combined with the following suggestions, will make a positive impact on consistent patient visits.

  • Verify contact information, and often. Appointment notifications only work if you are actually communicating with your patient. Confirm contact information at every appointment, and ask patients their preferred method of appointment reminders.
  • Text notifications. Texting is increasingly an expectation in medical practices. An appointment reminder system that uses SMS text messaging will improve attendance and responses.
  • Email notifications. Some patients respond better to email notifications, so having that option as part of your notification efforts will help cover the bases.
  • Business cards with contact information. If given the option, certain patients still appreciate taking home a business card with handwritten appointment day and time, as it provides a tangible reminder. It also provides quick access to the clinic phone number, should they need to cancel or reschedule.
  • Phone calls. They might seem old-school to some, but just like business cards, phone call reminders are still effective, particularly for those who prefer personal contact with a human voice.

Missed Appointment Policies

Having clear and concise policies for missed appointment and cancellation – and effectively communicating them to your patients – is vital for a successful chiropractic office. Whether you need to improve or tweak your policies, here are some things to consider.

You must inform your patients.

At the time a new patient schedules an appointment, be sure to specify your policies for missed appointments and cancellations. It would be best for policies to be:

  • explained verbally (at minimum)
  • posted in a conspicuous place
  • available in print as a handout, flyer, or part of a new patient packet
  • available on your practice website

Informing your patients should be part of office protocol and followed in the same manner with each patient, so as to ensure the patient was clearly informed and cannot later say they weren’t made aware of the policy. The burden of proof that the patient was made aware is on the chiropractor. This would include costs and what constitutes a missed appointment, such as less than 24 hours notice.

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Billing for missed appointments.

Policies that include charges for missed appointments are common, but the conditions for those charges vary. A standard approach is to charge patients a fee when they’re a no-show, or if they fail to cancel or reschedule at least 24 hours prior to the appointment. Typically, the fee is $20 to $25, but some offices charge the full amount for a missed appointment. The fear of the charge will usually influence a patient to keep an appointment or, at the very least, to contact the office before a set time in order to reschedule an appointment.

Offices often implement their policy based on the patient’s history. They are more forgiving if it’s their first occurrence or because of extenuating circumstances. If the patient frequently skips appointments or cancels/reschedules at the last minute, then fees are more likely. One upside of forgiving a patient fee is that they may likely be more respectful, or feel a greater sense of obligation to keep future appointments.

It’s important to remember that the purpose of such policies is to ensure compliance, and not to collect money.

Incentives: Programs & Marketing

It’d be nice if patients made it to all their scheduled appointments for the health benefits alone, but that’s usually not the case. It doesn’t hurt to get a little creative with your practice marketing, and offer incentives on a regular basis. Here are some ideas:

  • Give patients who show up for their appointments on-time an entry form for regular and ongoing drawings or contests. Give the winners inexpensive prizes, like gift cards, t-shirts, or tickets to local attractions or events.
  • Give patients the opportunity to prepay (or partial pay) for future appointments, and receive an added service or perk.
  • When patients cancel or reschedule ahead (allowing you enough time to adjust or schedule another patient), thank them and show your appreciation with a call, note, text or email.
  • Provide a modest discount to patients with on-time records as an incentive to show up.
  • Partner with a local business to give out free samples, a coupon or gift cards to not only reward on-time patients, but to also cross-promote both businesses.


Boosting participation without causing patients to feel unfairly penalized should be the primary goal when it comes to disincentives to missed appointments. Consider the following suggestions:

  • Modest fees. When a patient misses an appointment, charge a fee on their account to discourage no-show behavior.
  • Refundable fees. Place a fee on every appointment that is completely refunded when patients show up on-time.
  • Steps to dismissal. Implement a multi-step approach to deal with patients that frequently miss appointments, with the final step being to drop the patient and reject future visits. For example:
    Steps 1 & 2: make sure the patient is aware of the problem by sending a letter along with a copy of your missed appointment policy to the family after the first two times the policy is violated.
    Step 3: send a letter that places the patient on probation, and letting them know one more violation will result in dismissal from the practice.
    Step 4: Dismiss the patient by certified mail, with a copy by first-class mail in case they refuse the certified mail, and with a copy to the insurance provider if the patient is in managed care and needs to have the primary-care physician reassigned.

Get Started

Being willing to create reasonable policies and offer incentives to your patients is good for everyone involved. Because missed appointments are not only about lost revenue – they’re also about lost opportunities to improve someone’s health and wellbeing. Keeping that mindset and focusing on your patients will help drive your decisions and deal with the issue productively.

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ACOM Health