NO SHOW CLIENTS – Why it happens and what to do about it!

I hope you enjoyed my last article where I helped you develop a strategic plan to bulletproof your caseload.

If you haven’t had a chance to read about the 5 fool proof ways to make your caseload indestructible, please take the time to read it first, as the following information below relates back to the core fundamentals.

So let’s get started on a topic all us physiotherapists know about…No Shows (NS).

Clients don’t show and it interrupts our schedule and has a huge impact on our bottom line. Which is why we’re going to talk about why it happens and also lay out some practical tactics to change it.

Change your pre-programming

As PTs, we are pre-programmed by our common traits to attract chronic offenders. If there was a personality test that could predict common traits of the average PT, it would go something like this.

1) We are the preachers of the Church of Frugaltarians, and we often project our poverty mindset onto our clients (i.e. I don’t think I should charge them for that theraband, let a alone a missed appointment).

2) We undervalue our time as experts and overvalue the time of our clients.

3) We are complete push-overs so if someone arrives late we will still take them, even if that implodes our day!

4) Unless you’ve gone through 2 messy divorces, we are more comfortable in avoiding confrontation.

So, if I was a true narcissist patient who valued my time over anyone else’s, I would definitely make an appointment that I wouldn’t keep with my local physiotherapist!


Because I know that the average PT isn’t made to hold me up to the jackass I am!

So the question is, how can I safe guard myself from these energy vampires?

If you are doing all the 5 steps that I have outlined to bulletproof your caseload, chances are you won’t see these blood suckers at all.

The reality is, for the very silent majority of PTs that aren’t taking the time to build their tribe, no shows are a direct result of a failure to execute on investing in your clients. Investing in your client to make them feel appreciated, heard, inspired, validated, and of course, healed, are the basic pillars of patient attraction and retention.

So what do you do if it happens?

“If more information was the answer to success, then we’d all be billionaires with perfect abs” – Derek Sivers.

I personally love this quote, because it exemplifies the need to put information into action and more importantly being consistent with this ideology. When approaching a patient with tardy attendance, its critical to understand that there is a failure in connecting or understanding the needs of this client. Therefore, your goal is to understand why they are not attending. You need to revisit their goals for seeking treatment and most importantly open the lines of communication to get them back into the schedule on a consistent basis.

You can only do this by inviting conversation.The cardinal rule you shall not disobey is being a Physio Police Officer, don’t put them on the defensive or accuse them of wasting your time. If you do this please hand them the business card of your nearest competition.

So to assist in making it easier to have these difficult conversations with your client, I’m going to share with you actual scripts I use, scripts I normally only share with my private business clients.

No Show after initial assessment –

  • If the NS happens after the first visit – an immediate phone call from the primary therapist is needed. Remember the number of difficult conversations you are willing to have will dictate your ultimate success in life. So make that call yourself, don’t delegate it [EVER!].


Hey Jen, I just wanted to follow up with you after our first visit. I was thrilled to see how your issues being so complex localized to a few key areas of your body. I’m actually very excited because I’ve developed 3 key strategies to simplify the process of getting you back on track. I know you missed your follow up, but I did want to show you this plan, what’s your upcoming schedule like ? I know I’m fairly booked up but I will make room for you.”

No Show after subsequent appointment

  • Although most business coaches prefer to have a follow up phone call, I think a cleverly crafted email is actually a great way to engage patients and start a conversation.

Missed Just the single appointment

Hey Julie, Just wanted to touch base with you to see how your knee is doing? I wanted to make sure that you are in the schedule fairly soon so we can capture your goal of getting back on the ski slopes. When you get a chance send me an update so I can plan your next visit.”

The True Energy Vampire – A Chronic No Show or Late Cancellation Patient, what is your bottom line?

At this point you need to make an executive decision, you need to ask yourself the following questions:

Is this patient a good referrer for other clients?

Does this patient listen and respect your opinion when in the clinic?

Does this patient take up a reasonable time when they actually show up?

If the answer is no to any of the above questions, I would actually make the conscious decision to cease following up with them. You don’t have to pull a Trump and tell them they’re fired!

If the answer is yes however, I would follow up with this patient but make them aware that their progress is being impeded by their lack of attendance. Here are some sample scripts I would suggest.

“Hey Lance, How are you? I’ve noticed that you’ve been having trouble coming in for your therapy sessions over the last few visits. I know that your knee has been hindering you from going back to work, is there anything I can do to make it easier for you to make your appointments and get you back to your life?” 

“Hey Eric, Just thought I would reach out to you. I noticed you’ve had some issues making your last few appointments. I’m excited that you were reporting such incredible change in your over head lifts at Crossfit. I’ve got a new strategy to implement on how to get 3x more performance out your shoulder. The only problem is that you’ve missed our most recent sessions. I know how important it is for you to qualify for the provincial CF opens, so I’m eager to get you started on this protocol. Let me know how we can work your schedule for you to attend.” 

Policies and Charging the Patient

1) Make your point visible.

Put this in your patient intake forms and put up a sign near the front desk.

“We do our utmost best to get you in the soonest possible appointment, if you cannot make it for your visit please give us 24 hours notice so we can assist one of your fellow patients on their path to better health.”



It never hurts to remind people of common courtesy.

2) Forget Your Cancellation Fee and do something different!

The reality is, late cancel fees don’t get collected and are a reverse lead generator! So I’m going to give you an idea to turn a negative into a positive by simply thinking inside a box.

  • Set up a “Pay it Forward Box” – Get your patients to donate to a charity of the month for their missed appointment. They get to decide the donation and everyone wins.

Script – to put on the box

“We realize that sometimes life gets in the way with your treatment. In honour of respecting your time and ours we ask that if you’ve missed your appointment without cancelling that you donate to [Charity of the month]. Together our time and effort not only gets you back on track but betters the world around us.”

There’s so much more we could talk about caseload management and performance optimization, but there’s only so much space on this blog post.

The reality is, the better we are individually the more our profession will prosper. It is my humble wish for all of you to be true ROCKSTARS in your practice!

I would love to further this conversation or get your feedback, send me a message over twitter at @physiokarim, on Linkedin @KarimMeghji or at – all green lights to an epic 2017!


By | 2017-02-04T15:08:19+00:00 February 3rd, 2017|Blog|Comments Off on NO SHOW CLIENTS – Why it happens and what to do about it!

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