Appointments
Reducing no-shows and missed appointments
Why a clinic can hold every patient phone number and send no reminders at all, how to choose when they go out, and the cancellation policy that makes the difference.
A no-show costs a slot that cannot be resold. Unlike an unsold product, two o'clock on Tuesday does not carry over to the next day.
The usual response is to switch reminders on and move to something else. That is necessary but insufficient: reminders are a feature, whereas reducing no-shows is a policy. This guide covers both, starting with the check most clinics skip.
First, check that your reminders are going out
This is the check to make before anything else, because its failure is silent. A clinic can import two thousand phone numbers, enable reminders, and send no message at all, without any error appearing anywhere.
The reason lies in a distinction common sense does not make: a contact detail is not a consent. The phone number in the record indicates how to reach the patient, not that they have agreed to be reached.
The four conditions
A reminder is only sent if the following four conditions are met. The order is the one used in the check performed before sending, and each blocks by default.
| Condition | Where it is set |
|---|---|
| The channel is active for the clinic | Clinic settings, notifications section |
| The channel is active for this patient | The reminders tab in the patient record |
| The message type is enabled | Appointment reminder settings |
| Consent is recorded for that channel | The consent register, populated at data entry |
The patient level is the one that surprises people most. It works by opt-in: a patient with no preferences recorded receives nothing, even when everything is enabled at clinic level. Clinic settings determine what is possible, whereas the patient record determines what actually happens.
Consent is recorded per channel
Consent to text messages and consent to email are two distinct registers. A patient may accept one, the other, both or neither, and the absence of consent on a channel prevents any sending on that channel.
The method of consent is also recorded: written, verbal, electronic, or entered by the patient themselves. The question is asked at every point of data entry, but only for channels whose consent is not already recorded, so a patient is not asked twice.
Collect consent when the record is created, at the moment you enter the phone number and the email. Catching up later means calling every patient one at a time, which is exactly the work reminders were meant to save you.
Confirm with a test send
The notifications section allows a test message to be sent to a number or an address. Do it with your own contact details before considering the configuration complete, then repeat it on a real patient record. The first test validates the clinic configuration, the second validates the full chain, consent included.
Choosing when reminders go out
Sending times are chosen from intervals ranging from 168 hours, meaning one week, to 2 hours before the appointment. The same list applies to both channels.
Recently created clinics start with email reminders already enabled, one day and two hours before the appointment. Text messaging remains to be enabled manually, since it involves a per-message cost and a separate consent. Existing clinics keep their configuration.
Two reminders beat one
The two reminders do not serve the same purpose, and that is why two are needed.
Its purpose is to free the slot rather than to bring the patient in. Someone warned three days ahead who cannot come still tells you in time to fill the hour.
This is the one that genuinely protects your schedule.
Its purpose is to bring in the person who intended to come but forgot. It does not recover the slot, since it arrives too late to fill it.
This is the one most clinics enable first, and alone.
A clinic with only a two-hour reminder sees no-shows it could have converted into useful cancellations. Adding a reminder at 72 hours is the setting whose effect on occupancy is most visible.
What the reminder must contain
The message is written once and serves both channels, with a separate subject line for email and French and English versions. The language follows the patient's when it is specified in their record, and the clinic's otherwise.
Four elements are replaced automatically: the clinic name, the patient name, and the date and time of the appointment. Any other text in braces is sent as is, which produces an odd message for the patient if you invent a field.
The content matters as much as the sending. A reminder that announces the appointment without indicating how to cancel turns a possible cancellation into a no-show: the patient who cannot come and does not know what to do does nothing.
State, in one sentence, how to cancel and the notice expected.
The cancellation policy
This part is not configured in software. It is decided, written down and applied.
Three questions to settle before announcing anything.
What notice do you require? Twenty-four hours is the common threshold. It should correspond to the time you genuinely need to fill a slot, otherwise it is arbitrary.
What happens when it is not respected? A policy with no consequence is a suggestion. The consequence can be modest, but it must exist and be known in advance.
Who applies it? A policy applied by every second person does not hold. This is the most uncomfortable of the three questions and the one that determines whether the first two serve any purpose.
Announce the policy when the appointment is booked, then restate it in the reminder message. A rule discovered at the moment it applies is experienced as a penalty; the same rule announced twice in advance is experienced as a rule.
Recording what happened
Every appointment carries a status, which can be changed from the calendar, notably confirmed, no-show and cancelled. The status change is logged.
This recording looks administrative, and yet it is what makes the rest possible. An unrecorded no-show looks like an ordinary appointment in the history, which makes it impossible to know whether your situation is improving, or to identify the patients for whom the problem recurs.
Take up the habit of closing the day by recording statuses, rather than doing it at the end of the week from memory.
Following up after a no-show
The most effective reminder is the one that follows a no-show, and it cannot be automated.
Call the same day, while the reason is still fresh. The call has two purposes: rebooking immediately, and understanding what happened. A no-show caused by transport, a work schedule or a childcare conflict is solved by moving the appointment to another time of day, which no reminder will do for you.
Rebook during the call rather than offering to call back later.
Measuring
Two figures are enough, and neither of them is the number of messages sent.
The no-show rate, calculated from the statuses you record. That is the only reason to record them rigorously.
The time taken to fill a freed slot. A cancellation received three days ahead and never filled costs exactly as much as a no-show.
The notifications section also displays the volume of messages sent per channel over six months. That figure indicates that the mechanism is working, but it says nothing about the no-show rate. Do not confuse the two: an increase in message volume is not an improvement in itself.
What works and what fails
- Collecting consent when the record is created, at the same time as contact details
- Combining a distant reminder and a near one
- Stating in the message how to cancel and within what notice
- Recording statuses at the end of the day
- Calling the absent patient the same day and rebooking during the call
- Assuming the reminder goes out because the number is in the record
- Enabling only a two-hour reminder, which arrives too late to fill the slot
- Announcing a cancellation policy with no consequence, or applying it half the time
- Leaving statuses unrecorded, which makes any measurement impossible
- Tracking the number of messages sent while believing you are tracking the no-show rate
Frequently asked questions
We enabled reminders and nothing goes out. Where do we start?
With a specific patient record rather than with the clinic settings. Check that the channel is enabled for that patient and that their consent is recorded. That is the explanation in the great majority of cases.
Text message or email?
Email is enabled by default in recent clinics and costs nothing per message. Text messages are read more, but involve a per-send cost and a separate consent. Start with email, then add text messages for the slots where a no-show costs the most.
How many reminders before becoming intrusive?
Two suit most clinics. Three are justified for an initial assessment, where the slot is long and the patient does not yet know the clinic.
Can settings differ from one patient to another?
Yes. Clinic settings serve as defaults, and the patient record allows them to be overridden, including the sending language. A patient who chooses no sending times receives reminders at the times defined by the clinic.
Should no-shows be charged?
That is a clinic decision, not a software function. If you do it, announce it when the appointment is booked and restate it in the message. A policy applied unevenly damages the relationship more than having no policy at all.
Further reading
- Opening a new clinic on Bio6, where consent is collected from the first record
- Moving to Bio6 in 30 days, which covers carrying consents over during a migration
- Help centre, for the settings screen by screen
More guides
- Moving to Bio6 in 30 daysA four-week migration plan for a clinic changing software: who does what, in what order, and the difficulties to expect along the way.
- Making the most of Bio6's AI in your clinicWhat Cortex, Scribe and clinical relevance actually do, their usefulness in a clinic week, how to deploy them and what precautions to take.
- Opening a new clinic on Bio6Setting up a clinic from scratch, in the order of the startup guide: profile, team, first patient, first appointment, billing.
- Getting started with BioBandA guide for pilot clinics: pairing the band, positioning it, running a first assessment, and reading the measurement correctly.
- Completing the CNESST account of care and treatment (5055) in Bio6The full procedure: create the file, code the month's attendance, check the fields the 5055 requires, submit the period and follow the payment through.
- Running a successful clinic pilotHow to scope a four-week pilot, define success criteria before starting, choose the participants, and reach a decision you can defend at the end.
- Standardising your assessments with PROMsChoosing the questionnaires, deciding when to administer them, and reading a change in score: what makes results comparable across clinicians and over time.
- Configuring the phone assistantAnswering the calls nobody picked up: the forwarding to set up with your provider, the transfer line, and the thirty-second test that confirms it all works.
- Opening online booking without losing control of the scheduleThe confirmation mode, which services to open first, the booking window, and what to watch during the first month.