Hello there, and welcome back to the Mountain Practice Journeys podcast!

I’m your host, Cindy Norton.

Here in Episode 3 I’ll be introducing you to the specific elements that should be included in your cancellation policy and I’ll be helping you to design an agreement that you’ll have the confidence to uphold.

Let’s get started.


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See below for the episode show notes links and transcript…

Episode 3 Show Notes Links

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Episode 3 Transcript

Hello there, and welcome back to the Mountain Practice Journeys podcast! I’m your host, Cindy Norton. Here in Episode 3 I’ll be introducing you to the specific elements that should be included in your cancellation policy and I’ll be helping you to design an agreement that you’ll have the confidence to uphold.

Let’s get started.

Have you been wanting to start your private practice, but you can’t seem to take that first step? Maybe you’re afraid of failure or lack confidence, or maybe the idea of running your own practice is overwhelming. I’m Cindy Norton, owner of Mountain Practice Journeys and I help therapists and counselors to love the business side of private practice. I’ll share with you practical skills and advice along with a healthy dose of inspiration so that you can be on your way to the practice of your dreams. Put on your hiking boots, and let’s get going.

If you haven’t listened to Episode 2, check it out. I talk about the three P’s of private practice success which are Passion, Patience, and Persistence. I dig into each characteristic, how you can cultivate it, and why each is necessary as you start and grow your private practice.

Now let’s dig into today’s topic – how to create your cancellation policy. Oftentimes therapists feel lost or overwhelmed when coming up with policies and procedures for their practice, and they struggle even more when it comes to implementing them.

In today’s episode I’ll introduce you to some common elements that you may want to include in your cancellation policy. Additionally, I’ll help you to design an agreement that you will be able to uphold.

Throughout this episode I’ll be using the words “agreement” and “policy” interchangeably. When referencing the topic of late cancellations and no shows, I like to use the word agreement, as it reflects something that both me and my clients agree to – not something that is punitive or forced upon them.

Let’s get into the considerations you should take into account when creating your policy.

First, let’s talk about timeframes. For late cancellations, how far in advance will you allow clients to cancel before they will incur a fee? Many policies use 24-hour, 48-hour, or 72-hour timeframes. Personally, I have experimented with all these options and currently use the 24-hour timeframe.

What about fees? If a client late cancels or no shows to their appointment, how much will you charge them? You may decide on your full fee, or a set amount such as $50, $75, or $100. Or you may choose to do a tiered system, such as the first occurrence being waived, the second occurrence being $50, and the third and any subsequent occurrences being full fee.

Some therapists may not charge a fee at all, but refer out when clients begin to show a pattern of inconsistent attendance. I currently charge full fee for late cancels and no shows – but I do include exceptions, which I’ll talk about next.

In regards to exceptions, can the late cancellation or no show charge be avoided in any way? Many clinicians allow for exceptions if a client has an unavoidable emergency or has an illness. Other exceptions may be for a sick child or for inclement weather. Oftentimes, if the missed session can be filled or if the client reschedules within the same week they can avoid the fee.

Some policies are more strict and do not allow for any exceptions. I know several psychoanalytic therapists who see their clients weekly for years, and the client pays for their spot whether they attend the session or not.

Let’s talk about the possibility of offering waivers: Will you waive the first late cancellation? Or do you give any freebies? Counselors will sometimes use the first late cancellation or no show as a final reminder to the client that they will be charged if it occurs again. This is often referred to as the “get out of jail free” card.

I offer exceptions and waivers in my practice. I waive the late cancellation and no show fees for unavoidable emergencies, illness, or needing to care for a sick child. I used to waive the fee for inclement weather when I was seeing all my clients in my office.

Now that clients are used to teletherapy sessions, inclement weather isn’t an issue. I also give a freebie for the first late cancellation or no show, as it serves as a gentle reminder of the agreement.

You’ll also need to take into consideration alternatives. Will you offer video or phone sessions as an alternative if the client cannot make it to your office? Clients may have to cancel because of inclement weather or having to stay home with a sick child, but can otherwise participate in a session. And if they do not accept the alternative video or phone session, will you charge your fee then?

Other questions for consideration may include: Will you cap the number of late cancellations before you refer out? Do you reschedule after a no show for the first appointment, or immediately refer out?

I also think it’s important to talk about the impact of late cancellations and no shows on our practices. Late cancellations and no shows have a larger impact on a therapy practice than one may recognize. The affect on the therapist and their ability to make a steady income can be significant.

For the average practice, without a cancellation policy in place, one late cancel or no show a week could mean a $5,000 – $10,000 loss of income for the year. We still incur our expenses, such as rent, whether or not the client shows up for their session.

As counselors, we know that clients are not getting the maximum benefit of treatment if their attendance at therapy sessions is inconsistent. Cancellations can negatively impact the client and their progress in therapy.

Finally, if the therapist is unable to fill the missed session time it keeps another client from benefitting from the available time. Therefore, having a fair and clear policy in place will benefit both you and your clients.

I also believe in informed consent x2. I say x2 because it is important that your clients are truly informed; therefore, I recommend that they have at least two opportunities to be informed of and agree to your policies. Be sure that your policy on late cancellations and no shows is clearly written in your informed consent document. It should be easy for your clients to read and understand.

Although we would prefer that our clients read every word in our informed consent document, that doesn’t always happen. This is why it is really important to verbally go over your informed consent document, along with any agreements, during your first session with new clients.

When discussing your cancellation policy with clients you can say that you will hold yourself accountable for your end of the agreement, which means that you would only late cancel on them due to illness or emergency.

If a client is a no show to an appointment, I personally do not automatically charge their card until I know why they missed the appointment, as I’m checking for emergency or illness. I also want to have some contact with them so they can acknowledge that they know that their card will be charged and it will not be a surprise to them.

You’ll also want to make sure that collecting payment from your clients is an easy process. I highly recommend keeping a credit card on file that allows you and your clients to easily uphold the agreement.

You will need to have a system in place that has this feature available. I use Simple Practice* and love it! The software allows you to store and charge credit cards, among many other awesome features. *If you are interested in Simple Practice for yourself, you can check the show notes page for a link to get a free 30-day trial + a $50 statement credit when you sign up.

When therapists face a no show or late cancel, they will typically contact the client and remind them about the policy and inform them that they will be charging their card for the agreed upon fee. Having a valid credit card on file for all of your clients can ensure prompt payment of any late cancellation or no show fees.

When creating any type of policy for your private practice, you will need to take into account your outside contracts, specifically with insurance companies. I’m a private pay therapist so I’m not very familiar with the nuances of insurance and EAP programs as they relate to your ability to charge late cancellation and no show fees.

For example, some contracts that you may have do not allow you to charge any additional fees to your clients. Because of this you may want to decide how many late cancels or no shows that you will allow each client to have before you consider referring them out.

Please be sure to review your contracts to ensure that you will be able to enforce the agreements that you set forth in your informed consent document. If there are conflicts, you will need to adjust your agreement so that you are in line with what the contracted outside parties require of you.

I want to leave you with this piece of advice: do your own thing and don’t worry about others. There is no right or wrong way to set up your agreement. Know that everyone will have different views and opinions. You only need to do what works best for you and your business.

When the topic of late cancellation and no show policies comes up in some of the therapist forums, people can have very strong opinions on what they deem too harsh or too lenient, or not having good boundaries or being too strict.

Only you can decide what your business policies are going to be, and you also need to consider what agreements you will feel comfortable upholding.

This point about choosing an agreement that you will be able to uphold is really important. I’ve had many conversations with therapists where they share that their policy states that they will charge full fee for a late cancel, but when it comes time to enforce the policy they can’t bring themselves to follow through.

Maybe the client cancelled at 22 hours and the therapist is struggling with how much they are willing to flex on their 24-hour policy, or they just don’t feel good about charging $150 and not having a session to show for it. These feelings are so common amongst therapists grappling with doubts about their policies.

It’s easy to say “this is my policy” when you are creating your informed consent document, but I want you to take it a step further and imagine what it will be like to follow through with the policies and agreements that you are creating – because there will come a time when you have to enforce them.

And it’s okay if you need to adjust your policies, whether it is changing from a 24-hour to 48-hour time frame, or deciding to charge $50 for a late cancellation instead of your full fee. Whatever agreement you can follow through with is the agreement for you.

During each episode I’ll be giving you one small take away, action step, or mindset shift. I call these acorns. Listen to episode 0 to get the scoop on what the acorns are all about.

The acorn from this episode is to not only be confident in your practice policies, but to also share them with your clients. If you have a discussion about your policies with your client and get them on board with the agreement and include them in the consent process it will be so much easier for you to uphold the policy when it comes time.

As I outlined in episode 0, I’ll be alternating between a fun fact and ‘what I’m digging’ segment with each new episode.

SocialBee is what I’m digging for this episode. How many of you want to be active on your private practice social media accounts, but find it hard to keep up with posting regularly? I was having the same problem and just couldn’t keep up.

I finally decided that I needed to invest in a social media scheduler because I was spending way too much time trying to keep up with posting frequently enough in order to grow my social media following. I gave SocialBee a try and I haven’t looked back. I set aside an entire weekend and created a bunch of content and posts for social media and uploaded it into SocialBee and set up a posting schedule.

Now I have posts going out several times per week on Instagram, Facebook, and LinkedIn and I don’t have to do anything. It frees up time for me to meaningfully respond to comments and engage with the community on social media. As a result of the frequent and regular posting to my accounts and increased engagement, my social media following has significantly increased.

SocialBee is a social media scheduler that allows you to upload your posts and recycle them, saving you several hours every month. SocialBee organizes your content by categories so that you have a better mix of content based on best practice. You can schedule to post on Facebook, Instagram, Twitter, LinkedIn, Pinterest, and more. If you’re interested in SocialBee, head over to the show notes page and click on the referral link to get a free trial.

You can find the show notes at mountainpracticejourneys.com/episode3/

Thank you so much for joining me today on your private practice journey.

For episode 4 I’ll be chatting with Patrick Casale of Casale Coaching and Consulting. We’ll be discussing when it’s time to leave your agency job.

If we’re not yet connected on Instagram I’d love it if you would join me over there @mountainpracticejourneys

And a special shout out to Lydia Kickliter for her generous support of the podcast with her purchase of some Trailblazer apparel. Lydia is a private practice therapist in Asheville, North Carolina. She is the owner of Therapy for Showing Up where she helps women find their way back to their authentic selves. Helping them quiet the voices in their heads, clear out the trauma of their lives, and learn to finally trust themselves. Find out more about Lydia and the amazing work she is doing at therapyforshowingup.com.

There’s no way you can know how much it means to me that you choose to join me here as I share all things related to private practice. Please subscribe so you don’t miss a step. For more information about this episode, please visit the show notes page at mountainpracticejourneys.com/podcast I truly appreciate you Trailblazers. Your mountain is within reach. Journey on.

I Want You To Be Successful In Business & In Life!

Starting, growing, and maintaining a business is a big deal. It's super-exciting and super-scary all at the same time. I created Mountain Practice Journeys to support you through the difficult and muddy terrain, and to celebrate with you when you have reached each summit of the many mountains you will conquer on your journey.

Happy Climbing, Cindy

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