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Practice policy example

Missed appointment and cancellation policy

Illustrative example language for a cancellation and no-show policy. Fee practices are constrained by payer contracts and state law; adapt and verify before use.

Download the PDFPDF, 1 page, 4 KB. Free, no sign-up. For clinicians.
Educational example only. This is not legal, medical, or compliance advice, and it is not a ready-to-use legal document. Requirements vary by state, payer, and setting. Adapt anything like this to your own situation and have it reviewed by qualified legal and compliance counsel licensed in your jurisdiction before using it in a practice. You are responsible for compliance with all applicable federal and state laws, including HIPAA. shrinkiatry publishes professional commentary and education, not legal or medical advice.

Current as of July 7, 2026. Laws, payer rules, and billing codes change, so confirm the current requirements for your jurisdiction and setting before you rely on it.

What's inside

Example policy language

We ask for at least [24 to 48] hours' notice to cancel or reschedule an appointment. This lets us offer the time to another patient who needs care.

A cancellation with less than [X] hours' notice, or a missed appointment (no-show), may be subject to a fee of [$amount]. Insurance does not reimburse missed-appointment fees, so any fee is the patient's responsibility.

Repeated late cancellations or no-shows may affect our ability to continue offering standing appointments.

Notes for the clinician

  • Many payer contracts restrict or prohibit charging insured patients no-show fees; check your contracts
  • Some states regulate these fees; confirm yours
  • Apply the policy consistently and disclose it before the first visit
  • Consider reasonable exceptions for emergencies

About this resource

This template is part of the shrinkiatry resource library, a set of free, clinician-facing references and examples. It's reviewed by Shariq Refai, MD, MBA, FAPA, a board-certified psychiatrist, on a quarterly schedule. Next scheduled review: October 1, 2026. First published July 7, 2026, last reviewed July 7, 2026.

Browse the rest of the resource library, or verify who reviews this site. Spotted something out of date? Email corrections@shrinkiatry.com.

Educational and professional commentary only. shrinkiatry explains the profession of psychiatry. It doesn't provide medical advice, isn't a substitute for evaluation or treatment by a licensed clinician, and reading it doesn't create a doctor-patient relationship.