Late Cancellations, No Shows, and Late Arrivals in Private Practice

24hour cancellation late cancellations no show no-show private practice policies Feb 15, 2022

How should you handle late cancellations, no shows, and late arrivals in your private practice therapy business?  

Having policies and procedures in place for how to handle late cancellations, no shows, and late arrivals is an essential part of running a sustainable private practice. This article includes templates to get you started.

As a private practice coach, I suggest having policies and boundaries in place that you stick to 99% of the time, and then using your best therapeutic judgement in specific circumstances.

 Private practice boundaries allow us to build healthy, sustainable, and healing relationships with our therapy clients. If a client pushes back against one of our private practice policies, we can use their next session as a space to processes these feelings. But we also must recognize those occasions when we must be flexible (hello, pandemic).

There are going to be times when you feel confused about whether to hold your enforce one of your policies. In these moments, I want you to take a deep breath, pause, and call or text a therapist friend for a consultation. Oftentimes, setting boundaries can trigger our own fears of scarcity. And taking a moment to call a therapist friend and ask them how they would hand a certain circumstance can give us clarity.

Cancellations, no-shows, and late arrivals are a reality for private practice therapists. Regardless of whether you are a LCSW, LMFT, PsyD, or PhD having a solid plan in place will help you navigate these difficult conversations.  

How I Handle Late Arrivals and No-Shows as a Private Practice Therapist:

Step One: I list my late arrival policy in my paperwork:
  • “If you are running late, please contact me right away to let me know if you are on your way. If I have not heard from you within the first 20 minutes of your session, I will assume that you are a “no-show,” your session will be forfeited, and you will be billed at your full rate (even if there is time remaining in your session)”
Step Two: I give everyone one free pass on no-shows or late cancellations:
  • The first time a client no-shows or runs more than 20 minutes late, I cancel their appointment and let them know that I don't begin sessions more than 20 minutes late. However, I also let them know that I give everyone ONE free pass on the fee. And I offer then another time that week to reschedule.
Step Three: If I've given them one free pass and they no-show again:
  • I hold my boundary by texting something like this, "We had a session scheduled for 9 am and it is now 9:20 so I'm going to head out, and I will have to charge you for today's session. I hope you are doing okay, and I'm looking forward to seeing you next week."
 Step 4: If they press back against this boundary:
  • I say something like this,"I know that having me set this boundary can be frustrating. I would be happy to discuss this in our session next week."

Now, are you wondering how I handle late cancellations as a private practice therapist?

Step 1: The first time a client late cancels I send them this text:
  • “ Thank you for letting me know that you won't be able to attend our session today. Although I do have a 24-hour cancellation policy, I give all my clients one free pass. Next time, I will have to charge my fee for a late cancellation. I'm looking forward to seeing you next week”
Step 2: The second time they late cancel I send them this text:
  • “Thank you for letting me know that you won't be able to attend our session today. I have a 24 hour cancellation policy. I give each of my clients one free pass, but unfortunately you used yours on (date). So this time, I will have to charge your card for the late cancellation.”


Now you might be wondering, “Will some clients leave because of policies like this?”

Yes!  Some clients will get frustrated. Some clients will leave. And some clients will respect your policy. And this is where you need to use your best clinical judgment. There is a difference between a client who genuinely messed up and forgot your session and a client who chronically no-shows.

You have to use your own clinical skills to determine what boundaries are right for you and the population of clients you see.

- Written by Kelley Stevens, LMFT. Kelley Stevens is a private practice coach and consultant who works with therapists (LMFT, LCSW, LPCC, AAMFT, PsyD, PhD, etc) to help them build thriving private practices. 







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