agendessa
Free tool
Cancellation and no show policy template for clinics
The medical version of our cancellation policy generator: clear notice periods for patients, what happens if they are late or do not attend, and the exceptions for emergencies and illness.
The template is a starting point, not legal or tax advice. Rules differ between countries and change over time, so have it checked by a lawyer or accountant before you use it.
Download the PDF templateHow to use it
- Download the PDF and fill in your clinic name and notice periods.
- Check the text against your professional body's rules and your country's consumer law.
- Show the policy at reception, on your website and in the booking confirmation message.
- Apply the exceptions kindly: a sick patient should never come in just to avoid a fee.
What the template contains
The full text of the template. You fill in the blank lines.
Cancellation and no show policy
- Clinic or practice name:
- Address:
- Phone and website for bookings:
- In force from:
Why we have this policy
Every missed appointment is a slot another patient was waiting for. Please let us know in good time if you cannot come, so we can offer it to someone else.
1. Confirming your appointment
We send you a reminder hours before your appointment. Please confirm it or tell us if you cannot attend.
2. Cancelling or moving
You can cancel or move your appointment free of charge at least hours before, by phone, online or by message.
For tests and procedures that need preparation or specially ordered materials, the notice period is hours.
3. Late cancellation and no shows
If you cancel after the notice period or do not attend without telling us, a fee of may be charged.
The fee is not payment for medical care; it covers the time set aside for you.
After missed appointments, future bookings may need a phone confirmation or a deposit.
4. Arriving late
If you are more than minutes late, we may shorten or move your appointment so the next patients are not kept waiting.
If we are running late, we tell you as soon as we can and offer another time if you prefer.
5. Exceptions
We do not charge in case of a medical emergency, a hospital stay or events you could not foresee.
If you have a fever or symptoms that could spread, tell us and we will move your appointment free of charge.
Patients who are minors or need someone with them are booked together with that person.
6. Personal data
Your contact details are used for appointments and reminders, under the data protection rules of your country.
I have read and understood the cancellation and no show policy.
- Patient or legal guardian, signature:
- Clinic, signature:
- Date:
Do this automatically with Agendessa
Agendessa sends patients reminders with a confirm or reschedule link, and freed slots go to people on your waitlist.
Frequently asked questions
Can a clinic charge a no show fee?
In many countries yes, if the patient was told in advance. Clinics working with public health insurance may have special rules, so check them for your country.
What notice period is fair?
24 hours is the most common. For long procedures or ones that need materials ordered in, 48 hours is more realistic.
What about patients who miss several appointments?
The policy can say that after a number of missed visits, future bookings are confirmed by phone or with a deposit. Say it calmly and explain why.
Link to this tool
You are welcome to share this tool or link to it from your website, blog or newsletter.
