If you’ve been in practice for even just a few months, you’ve probably already experienced a client who called the same day of her appointment to cancel or reschedule.

If you are a therapist trying to grow your practice, you’ll agree that one of the most frustrating things is thinking an appointment is secure, only to have the client cancel. Or, just as your appointment book is starting to fill up, the phone starts ringing with clients requesting to move sessions to another time, or reduce the scheduled length of a session from 90 minutes to one hour.

When you don’t have control over your work schedule, you have an unfortunate situation I refer to as “your clients running your business.” Last-minute cancellations have a snowball effect if left to fester. This is an aspect of your practice that you need to take control of, rather than letting clients run the show. If clients are moving appointments or cancelling on you at the last minute, you have not yet perfected your cancellation elimination program. 

A client who cancels on you interferes with your plans for that day or week, and even one lost appointment a week can dramatically affect your income. Just as important, when a client doesn’t show for a prescheduled appointment, it can play havoc with the clinical results for which you are aiming. If clients don’t see the results they expect, they may not remember it is because you advised a frequency of twice a week, but they only saw you once a week due to their rescheduling. This, in turn, may affect their satisfaction with your work, and ultimately whether or not they continue to see you or refer others to you.

Once your cancellation elimination program is in place, you will begin to see fewer same-day cancellations, no-shows, and reschedules, and more revenue, schedule consistency, and sanity for you and your practice.

What You Call Your Policy

The first step in creating an effective cancellation elimination program is to always refer to your policy as a “Rescheduling Policy” rather than a “Cancellation Policy.”

This plants the seed in your client’s mind that it is assumed she is not cancelling altogether and will just rebook for another time or day.

5 Steps to Eliminate Cancellations 

1. Determine Need for Appointment
Knowing why a client is coming to see you seems simple, right? But many therapists never really think about why their client is coming in. To help make an appointment stick, you both need to be clear on why the client is coming in for a session with you. Discuss this in person, over the phone, or by email. (This is the “S” in your SOAP progress notes.) Zero in on the problem he is having, the condition or concern he is looking to remedy, or the situation he is hoping you can address. Once you’ve nailed down the exact reason for the visit, you will have a much easier time advising him on the frequency and number of visits you think would be best, and asking him to schedule the appointments.

2. Discuss the Session Advantages 

Explain the benefits you can provide clients. Be specific and paint a clear picture of the improvements you feel confident you can provide in the next session, or over a series of planned sessions. For example, you can help solidify the appointment by discussing how you will help a client lift her right arm higher so she can reach her cereal box on the top shelf. 

3. Set and Confirm the Appointment’s Time and Day

If you will be seeing a client for a number of sessions, it is best to confirm at least two weeks of appointments. This allows you to have a better idea of what your schedule is in advance, rather than just booking single sessions as you go.

4. Gather Credit Card Info

By asking for a credit card number to hold the reservation, you let clients know of the expected charges for the next session. 

5. Confirm Your Rescheduling Policy 

Determine what your rescheduling window should be. Then discuss the fee you will charge if your client reschedules too close to an appointment. (This is the most critical part of avoiding no-shows and cancellations.) Once you have a client who books an appointment with you, you absolutely must inform the client of this policy each and every time she schedules. Here is a sample script you can use: 

“Please remember I have a 24-hour rescheduling policy, so if you decide this time won’t work for you, please be sure to let me know at least 24 hours before your appointment. I would hate to have to charge you for a full session even if you won’t be using it. Does this work for you?”

Once clients say, “Yes, it works for me,” they have confirmed they know your rescheduling policy and will pay for the session should they need/want to change their appointment.

Once the appointment is scheduled, here is a tip to be sure it will stick: make reminder calls.

If you have the time, or have someone else available to do it for you, call clients 24-–48 hours in advance (at the very least call prior to your rescheduling window) and remind them of the day and time you are holding just for them.

The words you use are important: “Hi Jane, I am calling to remind you of your appointment with me for Wednesday, October 3, at 3:00 p.m. I am holding one hour for your session so we can work on ‘x, y, and z.’ I look forward to helping you feel better. See you Wednesday!”

It is extremely important you remind clients why they are coming in to see you and the benefits they stand to receive. “I am holding an hour for your session on Wednesday so I can help you with your stress from your new job. We’ll work on your breathing like you asked me to do, and I’ll help you relax and de-stress so you’ll have an easier transition over the next few weeks as you get used to all the changes.”

You need to reinforce for clients the benefits they will get from seeing you. They will start to visualize how much better they will feel, so they’ll be much less likely to cancel. Too often we think only about ourselves financially, and why we want clients to come in. Of course the appointments that stick help us, but remember—they also help your clients.

When it comes to leaving a voice message for clients, please notice I didn’t say anything like, “If this time doesn’t work, let me know,” or, “If you need to change it,” or anything like that. You absolutely do not want to give a client the option to bow out of an appointment. A cancellation won’t help clients reach their goals, nor will it help you be a successful massage therapist.

If clients get your call and were thinking about rescheduling their appointment, it may prompt them to do so. As long as it is outside your reschedule window, you might still have time to refill the timeslot with another client.

Creating Your Rescheduling Policy

There are many different factors to determining the right cancellation/rescheduling policy for your practice. Some questions to ask yourself when making your policy include:

1. Do you work for yourself or with other therapists? Decide how much notice you need or want to be able to accommodate the requests.

2. Based on your clients’ lifestyle, what window of time is reasonable? If you have clients whose jobs require last-minute meetings or clients with small children, your window might need to be a little more flexible. For example, we have a client who runs an international disaster-relief unit for the entire San Francisco Bay Area—it would be completely absurd for us to require him to give 24-hours notice when there is an emergency occurring. We know he only reschedules at the last minute when he has an emergency, so we trust him.

3. Determine what your exceptions to the policy will be. As noted with the client above, certain situations require flexibility. Things to consider here are sick clients (or their sick children), a death in the family, etc. If you have a first-time client who has a reason to reschedule, I suggest you waive the full fee. But—this is key—be sure to let her know you are waiving the reschedule fee. Say, “Mary, you are calling within my 24-hour rescheduling window, but I’ll go ahead and waive the fee for you since this is your first time with me. Please keep this 24-hour window in mind in the future because I will need to charge you next time.” Always use your best judgment.

How To Bill Clients for Missed Appointments

I suggest therapists always take a credit card from new clients to confirm the appointment. If you are not set up with a merchant account to allow you to accept credit cards, you can still easily bill clients’ credit cards through online sources such as Square or PayPal. Be very specific about your cancellation procedure in advance and have clients verbally agree that they will be obligated to pay you for any missed appointment.

Every time you book (or rebook) a client, you need to reiterate your cancellation policy. Even if he is calling at the last minute to come in within the hour, you’ll want to say, “John, I know you are leaving your office now to come down to see me, and just as a reminder, we are within my rescheduling window, so this is a confirmed appointment, right?” By saying these words, he is more committed to you and much less likely to call you in a few minutes and say he decided to go out for a drink with a friend instead.

Once you have a credit card on file, if the client then does not show or changes appointments within the rescheduling window, it is understood you will put the charge on the credit card. The key here is to be sure clients know your policy. It is unfair to tell a client you will charge her for something she didn’t know she was responsible for.

Some clients will not want to give a credit card in advance. If a client doesn’t want to give you a credit card, I suggest you say the appointment is tentative and not confirmed. Therefore, if someone else calls and wants that time, you will give it to the person who confirms with a credit card. If that happens, we call the first client (Client A) to let her know her appointment time has been given away to the second client (Client B).

Setting tentative appointments has four positive effects:

1. Client A knows you are serious about your time commitments and that you will hold the time reserved for her unless or until you get a confirmed appointment with Client B.

2. Client A is more apt to feel comfortable trusting you with her credit card once she sees how serious and business-minded you are.

3. If Client A is serious about wanting an appointment with you, she will somehow make it happen, usually by coming in person and prepaying for the session, or changing her mind and giving you a credit card.

4. If Client A is serious about wanting an appointment with you and does show up, you have an appointment.

In the few cases at our wellness center where a client did not want to give a credit card, we felt we did not lose out on anything, because people who are not willing to put their money where their mouths are usually aren’t clients who are committed to their well-being.

Rescheduling details

Rescheduling to come in earlier in the day or week is different. If a client calls prior to, or on the same day of, their session and wants to get in earlier—and you can do it—of course do it, and gently let her know you are making an exception to your rescheduling policy.

By seeing the client earlier, it frees up your later appointment times to hopefully get a last-minute client, or you get to go home early to enjoy some “me” time.

Time Shifting

If a client asks to reschedule, or to shorten his prearranged time from 90 minutes to an hour, keep in mind it is the same as cancelling 30 minutes. Don’t let him slide on this. Here are the words; practice saying this in advance, as it’s not easy to say but important to do.

Say, “Thank you for calling. I’ve reserved the full 90-minute appointment time for you, and of course I can shorten your appointment length, but since we are within my rescheduling window, and since I did not book someone else in your time and am holding it for you, I will still need to charge you for the full 90-minute session.” 

Yikes! Yes, it is possible to say this with a calm voice, integrity, and consideration for your client. Yes, it’s scary, and yes, he might not like it, but as long as he knew your policy in advance when booking the session with you, he can’t get mad at you for simply enforcing your own rules.

It’s important to create and state your cancellation/rescheduling policies in advance, both to inform veteran clients of your new guidelines, and to make sure new clients are fully aware of the consequence of cancelling. By having a policy in place, you are establishing expectations and creating a safety net to ensure you are in charge of your own schedule. 

 

  Irene Diamond, RT, is an educator, public speaker, and business coach who enjoys enlightening therapists, fitness trainers, coaches, and other “thera-preneurs.” Diamond will be inducted into the Massage Therapy Hall of Fame in 2013 for her work with Active Myofascial Therapy, and her online business resource, www.successfulmassagetherapist.org. Reach Diamond at www.facebook.com/therapysuccess, www.twitter.com/massageresource, or www.thediamondmethod.com.