Cancellation and no-show policy for physical therapy: a template

Why PT needs its own policy

A missed visit in a medical office usually means one lost slot. In a physical therapy clinic, it can start a chain. A patient planned for twice a week cancels a Thursday, doesn't make it up, comes once the next week, and three weeks later stops scheduling. That pattern is covered in depth in our guide to plan of care dropouts.

PT schedules also run on tighter constraints. Visits may be counted against an authorization or a plan-year visit limit, and an authorization can expire before a patient who keeps cancelling has used it. A good PT policy speaks to all of this in plain language: it asks for notice, offers an easy make-up, and explains why keeping to the plan matters, without promising or implying any clinical outcome.

The fill-in policy

Replace the bracketed text and keep the clause order. Clauses 4 and 5 are what make this a PT policy rather than a generic one.

1. Your plan of care. "Your therapist has recommended [number] visits per week for about [number] weeks. We book your visits in advance so your times are reserved."
2. Notice we ask for. "If you need to cancel or reschedule, please let us know at least [24 hours] ahead by replying to your reminder text or calling [phone number]."
3. Missed visits. "A visit is considered missed if you do not arrive within [10] minutes of your start time without contacting us. A cancellation with less than [24 hours] notice is a late cancellation."
4. Make-up visits. "When you cancel, we will try to offer you a make-up visit in the same week so your plan stays on track. If no time is available, we will offer the earliest time after that."
5. Repeated cancellations. "If [two / three] visits are cancelled late or missed within [30 days], your therapist will review your plan with you. This may include changing your visit times, your schedule, or [a fee of $___, where allowed]."
6. Authorizations and visit limits. "Some insurance plans approve a set number of visits, or approve visits for a set period. Missed visits can make it harder to use your approved visits before they expire. We will tell you if your approval is close to running out."
7. Exceptions. "Illness, emergencies and transportation problems happen. Please contact us, and we will work with you."
8. Applies to all patients. "This policy applies to all patients, regardless of insurance." Signature and date.

Saying it at the evaluation

The best moment to explain the policy is at the end of the evaluation, while the front desk books the plan. The patient has just heard the therapist's recommendation and is looking at their calendar. A short script:

"Your therapist would like to see you twice a week for six weeks, so let's get all twelve visits on the calendar now. Same days and times each week makes it easier. If something comes up, just reply to the reminder text a day ahead, and we'll find you a make-up time that same week so you stay on track."

Then hand over the written list of booked visits with the visit count on it. "Visit 1 of 12" tells the patient they're starting a series. For new patients who haven't arrived yet, the referral-to-evaluation stage has its own leaks; our guide to new evaluation no-shows covers it.

When a patient cancels: the make-up script

Clause 4 only works if the front desk offers the make-up on the same call or text. Waiting until "we'll call you when something opens" usually means the visit is gone.

On the phone: "No problem, thanks for letting us know. Let's keep your week on track. I can move you to Wednesday at 5:30 or Friday at 7:15. Which works?"

By text, minimum necessary: "[Clinic Name]: your Thu 4:00 PM visit is cancelled. Want a make-up this week? Reply 1 for Wed 5:30 PM, 2 for Fri 7:15 AM, 3 for other times. STOP to opt out." Never include the patient's name, the body part or the reason for the visit.

If the patient declines a make-up: note why. Cost, pain, doubt about progress and work schedules are different problems. Pass anything clinical to the therapist. That reason is often the earliest signal that a patient is about to drop off. Our PT cancellation recovery playbook covers what to do with each one.

Fees: check before you write a number

If you include a fee in clause 5, check payer rules first. Medicare, Medicaid and commercial plans each have their own rules on charging patients for missed appointments, and state law can add more. Our guide to no-show policies and fees summarizes the CMS guidance. Have your final policy reviewed against your payer contracts and your state's rules. This is general information, not legal advice.

Many clinics find that a therapist review after repeated cancellations works better than a fee. It puts the conversation where it belongs, with the clinician who set the plan, and it treats the pattern as a reason to talk rather than a reason to bill.

Measuring the policy

Track four numbers each week from your schedule export:

• Late cancellations and no-shows, by therapist and by day.
• Make-up rate: of visits cancelled this week, how many were made up within the same week.
• Refill rate: of slots released, how many were filled by another patient.
• Visits per plan completed: are patients finishing more of their planned visits than before the policy?

1. Illustrative math: a clinic sees 45 cancellations a week at an average visit value of $105.
2. If the make-up script saves 15 of those visits in the same week, that's $1,575 a week.
3. If 8 of the freed slots are also refilled by other patients, add $840.
4. Together that's about $2,400 a week, before counting the patients who finish their plan instead of quietly dropping off.