Handling No Shows and Late Cancellations in Private Practice

If you find yourself staring at an empty Jane room more often than you expected, or noticing red appointments scattered across your calendar each week, you're not alone. No shows and late cancellations happen in every private practice across Ontario (it’s part of the package, unfortunately!), but even when you anticipate the occasional missed session, it still throws things off when you don’t have clear policies or boundaries in place ahead of time. Because at the end of the day, you cleared the hour, prepped mentally, and turned away other clients who might've gladly taken that spot. And now there’s an empty block on your schedule with no realistic way to fill it.

Your time is limited and your sessions are your income. This is your livelihood, and it’s totally okay to have boundaries around that while still staying true to your values and showing compassion to your clients. A solid cancellation policy is simply part of running a functional practice! It sets expectations clearly and protects you from absorbing the financial and emotional impact of missed sessions.

Most therapists already lean toward some version of the same structure, even if they haven’t formalized it yet.

➪ Twenty-four to forty-eight hours’ notice to cancel

➪ The full session fee charged for late cancellations or no shows

➪ Exceptions for sudden illness or genuine emergencies

➪ A one-time grace option if they've never no-showed/late-cancelled before

Nothing here is harsh or unreasonable. It’s simply what allows your schedule, your income, and your energy to stay balanced. When clients know the expectations upfront, everything runs smoother for them (and for you!).

Honestly, clients usually just appreciate clarity! It prevents miscommunication, it removes guesswork, and it helps them take the commitment seriously without you ever having to chase or justify anything. And because this should already be included in your intake form, it’s something they’ve technically read and agreed to before their appointment anyway, so you’re not springing anything new on them. You’re just reinforcing what’s already part of the working agreement 😊

Here's an example of a follow-up email you can send in situations like these (to be tweaked as needed, of course):

Short, kind, and to the point. You’re not lecturing, you’re not apologizing, you’re not overexplaining. You’re just following through on an agreement.

There will always be moments where compassion comes first: sudden illness, last-minute emergencies, childcare issues, or situations a client truly couldn’t anticipate. Waiving the fee in those moments is pretty standard.

The key is being intentional instead of reacting out of guilt or pressure. A simple, “I’ll waive today’s fee given the circumstances, and we’ll continue with our usual policy going forward,” keeps everything fair clear!

If someone is repeatedly cancelling last minute or not showing up at all, it’s completely appropriate to enforce your policy, charge the late-cancellation or no-show fee, and even consider whether therapy should be paused until they’re able to attend consistently. As you know, there could be a variety of reasons behind this pattern, like scheduling issues, overwhelm, avoidance, burnout, something coming up in the work itself, or something totally unrelated. Either way, it’s reasonable to check in, explore what’s going on, and still maintain your boundaries!

This is where it might make sense to bring it into the next session:

And if the conversation needs to happen over email instead, then something simple and non-alarmist like this email template could work well:

It’s direct without being harsh, and it acknowledges reality without making the client feel scolded. You’re simply naming what’s happening, protecting your time, and making sure therapy is happening in a way that’s actually helpful for both of you.

Once you’ve created a cancellation or no show policy that feels aligned with your practice, it needs to live in a place where clients can’t miss it. That means putting it directly into your intake and consent forms, not just mentioning it verbally or relying on a line buried on your website.

When it’s part of the intake paperwork, clients read it, sign it, and agree to it before their first appointment. That makes every future conversation about missed sessions much easier because you’re simply referring back to something they already reviewed and approved.

It also removes that awkward feeling of “springing” a fee on someone. You’re not making a judgment call in the moment. You’re just following the policy they agreed to at the very beginning.

If writing policies isn’t your favourite task (and trust me, most therapists don’t enjoy it), this is where tools like AI can be genuinely helpful. You can draft a rough version, get support refining the tone, tighten up the language, and make sure it reads clearly before you ever add it to your forms. It saves a lot of time and removes the pressure of trying to get it perfect on the first try. 

And if you’d rather not do it alone, you can always reach out to us at Wellnix. We help therapists build policies, streamline their intake forms, and set up systems that support their practice. Clear admin reduces stress for both you and your clients, and it makes these tricky situations much easier to navigate.

Clear policies aren’t the “uncomfortable” part of private practice, but unclear ones are 😉 When you know your boundaries and your clients know what to expect, these situations stop feeling awkward and start feeling manageable. It frees up your time, your energy, and your headspace so you can focus on the part of your work that you enjoy!

And if you want help getting your forms, policies, or practice workflows cleaned up and running smoothly, just reach out! Our team at Wellnix Virtual Assistance specializes in supporting Canadian therapists and Ontario private therapy practices with admin systems, intake forms, cancellation policies, and day-to-day practice management. Whether you’re a solo practitioner or growing your team, we’re here to help your practice run the way you want it to!