A Fair Approach to Missed Appointments: Why We Have a Fee

As therapists, we understand that there are so many reasons why a client may not be able to attend a scheduled appointment. In this blog, we’re going to cover the purpose behind our missed appointment fee, and why it’s in place to improve the therapy practice. 

At Two Doves Psychotherapy Services, no-shows and cancellations made within 5 hours of a scheduled appointment are subject to a $40.00 penalty. 

Let's cover the drawbacks of this penalty.

Financial Burden
For many, therapy can already be a financial stretch, and a missed appointment penalty due to a situation out of one's control could discourage clients from seeking treatment, making accessibility even more difficult.

Adding More Stress
Emergencies and unforeseen circumstances are always a part of life, and knowing that these fees are written in our contract can place extra stress on already stressful situations.

Damaging our Alliance
Missed appointment fees also run the risk of damaging the therapeutic alliance if appropriate communication and guidelines are not disclosed. We never want to make clients feel as if we are prioritizing profit over them - so keep reading!

Why are missed appointment fees so important?

Missed appointment fees allow fairness to our time and practice. 
Unfilled appointment slots mean lost potential income and time that could have been used for continuing education, administrative work, or seeing a waitlisted client. Late cancellation and no-show fees can help cover some of these lost costs to ensure we can continue to serve our community.

Accountability
Most importantly, these fees help encourage clients to incentivize and take appointments seriously. Missed appointment fees have shown promise in promoting commitment and reducing no-shows. A systematic review of 105 papers has shown that the average no-show rates to be 23% (Leibner, Brammli-Greenberg, Medlovic, & Israeli, 2023)! That’s more than 2 in every 10 appointments! 

Prevention of Dual Relationships
These fees also help prevent dual relationships. As stated by College of Registered Psychotherapists of Ontario (standard 6.1.6: Fees, 2025), “Registrants should not barter their services with clients due to the risks of dual relationships and conflicts of interest.” To protect our clients, we enforce fees to maintain fairness under this professional standard.

We understand that life, emergent circumstances and accessibility issues can easily occur and are taken into consideration when appointments are missed. Our clients’ best interest is always at the forefront of our services and this is something we strive not to overlook. 

References:
Fees. College of Registered Psychotherapists of Ontario. (2025). https://crpo.ca/practice-standards/business-practices/fees/ 

Leibner, G., Brammli-Greenberg, S., Mendlovic, J., & Israeli, A. (2023). To charge or not to charge: Reducing patient no-show. Israel Journal of Health Policy Research, 12(1). https://doi.org/10.1186/s13584-023-00575-8 

Therapy brands. (2025, February 4). The Dilemma of Cancellation and No-Show Fees: Re-evaluating Your Policy. Therapy Brands . March 27, 2025, https://therapybrands.com/blog/the-dilemma-of-cancellation-and-no-show-fees-re-evaluating-your-policy/ 

Werner, K., Alsuhaibani, S. A., Alsukait, R. F., Alshehri, R., Herbst, C. H., Alhajji, M., & Lin, T. K. (2023). Behavioural economic interventions to reduce health care appointment non-attendance: A systematic review and meta-analysis. BMC Health Services Research, 23(1). https://doi.org/10.1186/s12913-023-10059-9