Remind Clients About Appointments
Clients miss assessment appointments and treatment
sessions because they forget about appointments.
Call clients 24-48 hours in advance to remind them about
their next appointment.
CAB Health and Recovery in Peabody, Massachusetts
reduced no-show rates to intake appointments by 27
percent and increased participation rates for patients
continuing from assessment to their first appointment by 23
percent. They had the evening staff make reminder phone calls during periods of lower volume
and when clients were more likely to be at home to receive the call. For more information, see
the case study.
Racine Psychological Services in Racine, Wisconsin increased the attendance rate from 47
percent in August 2005 to 72 percent in January 2006 by asking outpatients if they wanted to be
reminded about their appointments by phone. If so, they asked what phone number to call and
whether it was OK to leave a message. A customer-friendly person made the reminder calls.
- Ask clients if they would like to receive a reminder call in advance.
- Make reminder calls when you’re most likely to reach the client—e.g., late afternoon or
- Use text messages to remind adolescents and young adults.
- Caution: Some NIATx providers have found that making reminder phone calls actually
resulted in higher no-show rates, so be sure to test this promising practice on a small
scale and refine it so that it works at your site. There are a number of reasons that
reminder calls may not decrease no-shows:
- Having the wrong person make the reminder call. A case manager or counselor may
be better prepared to address issues that come up than a receptionist.
- Not being able to reach clients because they don’t have phones.
- Not leaving a message to maintain confidentiality if the client didn’t answer.
- Sending postcards or letters rather than making phone calls. If you have time to send
a letter, revisit the promising practices for reducing waiting time.
- If you decide to make reminder calls for the first face-to-face session and also
subsequent sessions, implement the changes as two separate Change Projects, focusing on two separate aims:
- Reduce no-shows to assessment appointment
- Increase continuation during treatment.
This approach will make it easier to determine what kind of reminder call works best for a
client who has never been to your agency as opposed to a client who is returning. The type
of conversation is likely to be different.
For assessment appointments:
- Have counselors who will be doing the assessments make the reminder calls so they
can begin to establish a therapeutic relationship with the client.
- Remind clients about appointments 48 hours in advance, so that if they need to
reschedule or cancel, there is enough time to schedule someone else.
- Keep a list of clients willing to come in sooner, in the event that there’s a cancellation; or
offer canceled appointments to incoming callers.
- Find out with whom you can leave a reminder message if the client does not have a
- Use the reminder call as an opportunity to ask clients if they have questions or concerns,
logistical problems, or other problems that might prevent them from coming to the
- Use the reminder call to help overcome the client’s reluctance to come in the first time
and provide an opportunity to establish a connection before you meet in person.
For ongoing treatment sessions:
- Remind clients about appointments for individual and group treatment sessions.
- To minimize the time required to make reminder calls, make reminder calls only to clients
who have missed appointments in the past.
- Determine at what point clients most often drop out of treatment—for example, between
the first and second treatment session, etc.—and make reminder calls to clients that are
at that stage of treatment.
No-show rate for assessment appointments or
Data Collection Form
No-show Tracking Spreadsheet
- 1. Select the service activity for which you will be making reminder calls—for
example, assessment appointments, group sessions, or one counselor’s
- 2. Identify the staff person who will be responsible for making reminder calls.
- 3. Develop a simple script for this person to use when making reminder calls.
- 4. Collect baseline data for the no-show rate for this type of appointment,
without reminder calls.
- 5. For the next forty clients or the next two weeks, whichever happens first,
ask clients in advance whether they want a reminder call and whether you
have their permission to leave a message.
- 6. Make reminder calls to the clients that wanted them and keep track of
whether you reached them, left a message, were unable to reach them, or
had bad contact information.
- 7. Track and calculate the no-show rate at the next appointment for clients
who received a reminder call.
- 8. Check the fidelity of the change. Was the change implemented as planned?
- 9. Evaluate the change:
- What percentage of the clients that you called did you actually
- Was it easier to reach clients at a particular time of day?
- Did the no-show rate decrease when clients received reminder
- Adjust the script, the timing of the reminder calls, the person making the
calls, or the way that you request reliable contact information and re-test
this promising practice for an additional two weeks.
Repeat this series of steps until you are satisfied with the system for making
reminder calls and so that all patients who need and want reminder calls are
receiving them. Expand this practice to make reminder calls for other group or
individual sessions for which there is a high no-show rate.
Daybreak Youth Services in Spokane, Washington reduced no-shows from 22.2 percent to
15.4 percent over a period of 2 months by making reminder phone calls. One counselor, with
the help of a secretary, began making reminder calls to all of her clients the day before their
appointments. This counselor’s no-show rate showed quick improvement so the practice was
expanded to all clinicians and sites. For more information, see the change bulletin.
MECCA in Des Moines, Iowa reduced no-shows by 44 percent by calling clients to remind them
about their appointments.
Port Human Services in Greenville, North Carolina reduced no-shows by 50 percent by calling
clients who missed a methadone dose to remind them to come in.