Free practice template
Medical no-show policy template + how to actually enforce it
Copy, adapt, and share a policy your team can explain in plain language.
Last reviewed: October 2, 2026
Use this template
Replace the bracketed choices before publishing. Have the appropriate person review the final policy for your practice and patient population. This is a customizable operational starting point, not legal advice.
[Practice name] missed appointment and late-cancellation policy
Our goal. We reserve appointment time for each patient. If you need to change your visit, please tell us as early as you can so we can offer the time to someone else.
Notice period. Please cancel or reschedule at least [number] [hours / business days] before your appointment by [phone number / portal / other accepted method]. If the office is closed, [explain how notice is recorded and when it counts].
No-show. We consider an appointment a no-show when [define how long after the scheduled time and whether any contact changes this status].
Late cancellation. We consider a cancellation late when we receive it less than [number] [hours / business days] before the appointment. [State whether this includes rescheduling.]
Possible fee. For a covered no-show or late cancellation, we may charge [fee amount or fee schedule]. [State whether there is a first-incident waiver, any visit-type differences, and any limit on frequency.] We review each case before deciding whether to charge; the fee is not automatic.
Exceptions and questions. We consider [practice-defined exceptions, such as emergencies, severe illness, transportation disruption, or office error]. Contact [team/contact method] within [timeframe, if used] if you believe the record is incorrect or an exception applies. We will review the information and explain the outcome.
Communication and acknowledgment. We share this policy [at booking / in intake materials / in the portal / by secure link]. Before a covered appointment, we ask patients to [acknowledge the terms / sign / confirm electronically]. We keep a record of the version accepted and the date.
Effective date. [Date]. Policy owner. [Role or team].
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Before you put it in front of patients
- Choose a notice window your staff can apply from the appointment record.
- Decide which visits and patients are eligible under your practice’s terms and applicable rules. Do not assume one fee policy covers every appointment.
- Write exceptions staff can recognize and a route for cases that need a manager’s review.
- Make the fee visible before the appointment, and keep a record of what the patient acknowledged.
- Train the team on who records a missed visit, who decides a fee, and how questions are handled.
Writing the policy is only step one
A policy in a PDF does little if each staff member must remember whether the patient saw it, decide an exception alone, and request a card after the fact. A workable process connects the accepted terms to the appointment record and gives the team a defined review step. Our fee collection guide maps that process, and the dispute guide covers what to do when a patient disagrees.
SureAppoint can show terms and a possible fee to patients for selected eligible appointments and save a payment method before the visit. The practice reviews what happened later and makes the fee decision. SureAppoint is not currently available for Medicaid or Medicare-Medicaid dual-eligible patients. See how it works and pricing.
Frequently asked questions
What should a medical no-show policy include?
Define a no-show and late cancellation, the required notice period, any fee and exceptions, how patients receive and acknowledge the terms, and how the practice reviews and communicates decisions.
Can I copy this policy into my practice materials?
Yes. Replace every bracketed choice and adapt the text to your practice and applicable requirements before using it. This is an operational template, not legal advice.
Should every missed appointment result in a charge?
No. The practice should check the facts, its documented exceptions, and the terms accepted for that appointment before deciding. A consistent review process can also result in no fee.
Turn written terms into a repeatable workflow.
See how patients can review terms before selected appointments and how your practice stays in control afterward.