What is the average patient no-show rate for appointments?

A review of 105 studies from several countries, published in Health Policy in 2018, found 23% no-shows on average. In Brazil, a primary care unit in Pelotas measured 19.2% across 3,131 appointments (RBMFC, 2018). There is no published rate for Brazilian private clinics.

Do WhatsApp reminders reduce patient no-shows?

Yes. The 2013 Cochrane review, with 8 trials and 6,615 participants, shows 78.6% attendance with a text reminder, against 67.8% with no reminder. Phone calls had a similar result, at a higher cost.

Can a clinic charge patients a no-show fee?

It depends on the profession. For physicians, the CFM holds that a no-show fee violates art. 59 of the Code of Medical Ethics. For other professions, we found no specific federal rule; confirm with your regional council and write the policy before booking.

Can I charge a deposit to book an appointment?

The deposit is provided for in the Civil Code (arts. 417 to 420) and is deducted from the price when the appointment takes place. Under the Consumer Protection Code, the rule must be disclosed in advance and cannot be disproportionate. For physicians, the CFM's position against charging applies.

How do you calculate the clinic's no-show rate?

Divide the month's no-shows without notice by the total booked slots and multiply by 100. Count cancellations with less than 24 hours' notice and rebookings separately, to know where to act.

What should you do when a patient doesn't show up?

Record the no-show the same day, offer the open slot to the waitlist and create a rebooking task with an owner and a deadline. Without an owner, rebooking gets put off.

Patient no-shows: what they cost and how to reduce them with confirmation and deposits

By Igor Costa · October 26, 2026 · 6 min read

On average, 23% of appointment slots end in no-shows, according to a review of 105 studies published in 2018. To reduce patient no-shows, measure the right rate and confirm by WhatsApp the day before. Write the rebooking policy, and the patient accepts it when booking. A deposit helps when it becomes credit toward the session.

What do patient no-shows cost the clinic?

A no-show costs the price of the session that didn't happen, plus the provider's idle slot. In a clinic with 400 sessions a month, each point of no-show rate is worth 4 sessions.

The benchmark numbers come from outside private clinics:

Worldwide: the review by Dantas et al., in Health Policy in 2018, brought together 105 studies and found 23% no-shows on average. The time between booking and the appointment and a history of no-shows were the strongest factors.
In Brazil: a primary care unit in Pelotas recorded 598 no-shows in 3,131 appointments, or 19.2%, between July 2016 and April 2017 (RBMFC, 2018).
In private clinics: there is no published rate. A survey by Conclínica, a software company, says 42.2% of private clinics have trouble confirming appointments (Medicina S/A, September 2, 2024). It is a vendor survey, with no sample disclosed.

The table uses example numbers: 4 providers, 400 sessions booked in the month and a R$ 150 session.

No-show rate (example)	Sessions lost in the month	Revenue held up in the month	Revenue held up in the year
10%	40	R$ 6,000	R$ 72,000
15%	60	R$ 9,000	R$ 108,000
20%	80	R$ 12,000	R$ 144,000

Not every no-show is a permanent loss. Some slots come back through the waitlist, and some patients rebook. The math shows the ceiling of the problem, and the work is recovering as much of it as possible.

How do you measure the no-show rate the right way?

Divide no-shows without notice by the total booked slots in the month and multiply by 100. Count what is not a no-show separately, because each case calls for a different action.

Situation	Counts as a no-show?	What to do
Didn't come and didn't call	Yes	Rebooking task the same day
Canceled with less than 24 hours' notice	Separately (late cancellation)	Offer the slot to the waitlist right away
Canceled with more than 24 hours' notice	No	Rebook and free the slot
Rebooked by link or through the front desk	No	Nothing, if the new date was set
Arrived late and wasn't seen	Separately	Review the grace period rule

With this split, the clinic finds where the problem is. If most of it is late cancellation, the waitlist pays off more than charging. If it is no-shows without notice, the focus is confirmation.

Also measure by provider, by day of the week and by the time between booking and the session. The 2018 review points to this interval as one of the factors most linked to no-shows.

Do WhatsApp reminders reduce no-shows?

Yes, and the evidence is old. The Cochrane review by Gurol-Urganci et al., from December 2013, brought together 8 trials with 6,615 participants. Attendance was 78.6% with a text reminder, against 67.8% with no reminder.

Phone calls had a similar result (80.3%), but they take more front desk time. A message gets close to that with less work.

Three precautions make the reminder work:

Ask for a reply. "Can you confirm your session tomorrow at 15:00? Reply 1 to confirm or 2 to rebook." A reminder without a question doesn't show who will miss.
Bring the reply into the schedule. If the front desk copies the reply by hand, the slot of whoever asked to rebook stays taken until someone sees it.
Get the patient's opt-in. The WhatsApp Business policy, updated September 23, 2026, requires that the person gave their number and agreed to receive messages. Record that opt-in in the patient file.

Send it the day before, with time to rebook. For patients who booked far in advance, a second notice a week before helps free the slot in time.

Can the clinic charge a no-show fee or a deposit?

It depends on the profession and on how the policy was agreed. For physicians, the answer is no. For other professions, the policy must be written, disclosed in advance and proportionate.

Medicine. The CFM holds that a booking fee or a penalty for absence violates art. 59 of the Code of Medical Ethics. The position appears in council opinions from 2015 and 2022, summarized by Migalhas in April 2025. If your clinic has physicians, charging for their no-shows is off the table.
Physical therapy, psychology, dentistry, nutrition and aesthetics. We found no federal rule from COFFITO, CFP or CFO addressing no-show charges. Before adopting one, confirm with your profession's regional council.
Consumer Protection Code. The contract does not bind the patient if they had no chance to see the text beforehand (art. 46). The information must be clear (art. 6º, III). A clause that creates an excessive disadvantage is void (art. 51, IV).
Civil Code. The deposit, called arras, is in arts. 417 to 420. When the appointment takes place, the deposit is deducted from the price.

In practice, a deposit that becomes credit is easier to defend than a penalty. The patient pays part when booking, and the amount goes toward the session. If they give notice in time, the credit moves to the new date.

Under art. 46 of the CDC, a rule the patient did not see beforehand does not bind them. That is why acceptance at booking matters as much as the amount.

How do you write the clinic's rebooking policy?

A good policy fits in five lines and appears at the moment of booking. This is an example to adapt with your lawyer and your council:

Confirmation arrives by WhatsApp the day before the session.
Free rebooking is allowed up to 24 hours before the appointment.
The R$ 50 deposit becomes credit toward the session or the new date, when notice arrives in time.
On a no-show without notice, the clinic keeps the deposit, and the front desk offers a new date.
If the clinic cancels, the deposit is refunded in full or becomes credit, at the patient's choice.

Item 5 keeps the policy balanced. Without it, the clinic charges the patient for what it doesn't charge itself.

Keep proof of acceptance: date, time and channel. If there is a dispute, the clinic shows that the policy was disclosed in advance.

How CERNE solves it

CERNE brings confirmation, deposit, no-show and waitlist into one workflow, connected to the clinic's schedule.

Confirmation by WhatsApp. The reminder goes out the day before, and the patient's reply goes back into the schedule. A patient who asks to rebook frees the slot right away.
Deposit by Pix with the accepted policy. The patient picks the slot, accepts the rebooking policy and pays the deposit in the same link. The amount becomes credit toward the session.
The no-show becomes a task with an owner. A patient who misses goes into the "Rebook" column, with an owner and a deadline. CERNE follows up until the task closes.
Waitlist. The freed slot goes to the first person on the list, and the provider isn't left idle.
Direct question. In the AI assistant, management asks "how much did the clinic lose to no-shows in October, and who didn't rebook?". The answer comes from operations data, and the outreach only goes out with your approval.

CERNE's health package was born in the operation of Avittá Fisioterapia, which gained more than 100 new clients in one year, with good retention. See the workflows on the health and wellness page and the cards for each function.

Start with the assessment

The table in this text uses example numbers. Your clinic's uses your schedule. Start with an assessment of your operation: our team measures the no-show rate by provider and builds the confirmation sequence with you. Book the assessment.

Frequently asked questions

What is the average patient no-show rate for appointments?: A review of 105 studies from several countries, published in Health Policy in 2018, found 23% no-shows on average. In Brazil, a primary care unit in Pelotas measured 19.2% across 3,131 appointments (RBMFC, 2018). There is no published rate for Brazilian private clinics.
Do WhatsApp reminders reduce patient no-shows?: Yes. The 2013 Cochrane review, with 8 trials and 6,615 participants, shows 78.6% attendance with a text reminder, against 67.8% with no reminder. Phone calls had a similar result, at a higher cost.
Can a clinic charge patients a no-show fee?: It depends on the profession. For physicians, the CFM holds that a no-show fee violates art. 59 of the Code of Medical Ethics. For other professions, we found no specific federal rule; confirm with your regional council and write the policy before booking.
Can I charge a deposit to book an appointment?: The deposit is provided for in the Civil Code (arts. 417 to 420) and is deducted from the price when the appointment takes place. Under the Consumer Protection Code, the rule must be disclosed in advance and cannot be disproportionate. For physicians, the CFM's position against charging applies.
How do you calculate the clinic's no-show rate?: Divide the month's no-shows without notice by the total booked slots and multiply by 100. Count cancellations with less than 24 hours' notice and rebookings separately, to know where to act.
What should you do when a patient doesn't show up?: Record the no-show the same day, offer the open slot to the waitlist and create a rebooking task with an owner and a deadline. Without an owner, rebooking gets put off.

CERNE for Health and wellness. Multi-provider schedule, confirmation, records, packages, provider payouts and the patient portal in one system. AI works inside the operation, and a team supports your management. See how it works or start with an assessment of your operation.

Sources

Igor Costa · Partner at IF Soluções, with more than 10 years in communication and process auditing. At CERNE, leads each client's assessment: follows the operation, maps where time and money are lost and decides which workflows to digitize first. Followed the rollout at Ammo Burger, EClub and Avittá.