A reminder the day before, and fewer missed appointments

A client who does not show up is a lost hour, a treatment that never happened, and often a slot someone else would have taken. Most practitioners know this, and many still send their reminders by hand, the day before, between appointments. This article looks at what the studies actually say about automatic reminders, what a missed appointment costs a small practice, and what a reminder that sends itself looks like.

1. How many appointments are missed, really

There is no single number. In Quebec, a study published in 2020 in Canadian Family Physician counted missed appointments in four university family-medicine clinics: 7.8% on average (2,700 missed appointments out of 34,619), ranging from 6.3% to 9.0% depending on the clinic. Elsewhere in Canada, CMAJ reported in 2020 rates ranging from 1% to 13% in individual practices, and up to 25% in one downtown clinic in Saskatchewan. An "international average of about 23%" is often cited, but without a solid primary source: take it as an order of magnitude, not a fact.

What is more interesting than the rate is the reason. In the Quebec study, among patients who did not call ahead, 55.2% simply say they forgot to call. And among clinic-related reasons, 13.7% cite the lack of a confirmation. In other words: a good share of no-shows are not refusals, they are forgetting.

2. What the studies say about reminders

The most-cited review remains the Cochrane one (2013): eight randomized trials, 6,615 participants. Text-message reminders improve attendance, with a relative risk of 1.14 (95% confidence interval of 1.03 to 1.26). In plain English: people who receive a text show up a little more often, on the order of 14% more on average. Text performs as well as a phone call (relative risk of 0.99), for a fraction of the time.

A more recent systematic review (BMC Health Services Research, 2023) surveyed 56 studies on reminders: 15 find a significant drop in no-shows with text messages, 4 find nothing, 1 finds the opposite. The effect is real, it is not magic, and it depends a lot on how the message is written.

Wording does matter. In the United Kingdom, two randomized trials (PLoS ONE, 2015) compared an ordinary reminder to one that names what a missed appointment costs the health system: no-shows dropped from 11.1% to 8.4%. In Israel, across 161,587 people, a generic message gave 21.1% no-shows in a hospital setting, against 15.3% for a message that named the cost of the appointment. These baseline rates are much higher than a small Quebec practice would see, but the lesson holds: a reminder that says why it matters works better than one that only says when.

And the cost? In Geneva, a trial compared the day-before reminder by text and by phone call: €0.07 per text against €0.08 per call, plus staff time. The authors conclude that only text is cost-effective. An automatic email costs even less.

3. The "I confirm" button: what we know, and what we don't

Honestly: no study isolates the effect of a confirmation button on its own. One orthodontics study (2018) found no difference between phone, email and text, and its authors only write that a chance to confirm "might" reduce no-shows. That is a hypothesis. Software vendors' blog posts claim the opposite with confidence, with no study behind them.

What we do observe, on the other hand, is the effect on cancellations: in the Israeli trial, every message carried a link to confirm or cancel, and the most effective wordings pushed advance cancellations up (26.3% against 17.2% for the control message). A cancellation the day before is a slot you can fill. A no-show is not. That is why I put the button there: not because it guarantees attendance, but because it turns silence into information.

4. What a missed appointment costs you

Rather than a "typical" number, a formula, to fill in with your own numbers:

missed appointments per week × average value of an appointment × weeks worked per year

Example for a massage therapist who works 46 weeks, bills $95 per treatment and loses 2 appointments a week: 2 × $95 × 46 = $8,740 CAD a year, not counting the time spent following up and rescheduling. If the automatic reminder prevents one in four, that is $2,185 CAD a year. Run the numbers with your own figures: it is often the most honest way to decide whether automation is worth it.

5. What a reminder that sends itself looks like

In a small practice, the journey fits in five moments, none of which you need to remember:

• At booking: a welcome email, in your voice, with your instructions and your cancellation policy, readable before the appointment.
• The day before, at 9 a.m.: the reminder, with the "I confirm" button and a link to cancel.
• The day before, at 6 p.m.: if nothing has been confirmed, you get an alert on your phone. You decide whether to call or not.
• Two hours after the visit: your advice, the payment link, your review link.
• Seven days later: if payment has not come in, a gentle follow-up, written in your own words.

All of this connects to the booking tool you already use (Square, GOrendezvous, Cal.com, Calendly) and to your email address. The wording is yours, reviewed with you. The tools stay in your own name, and their subscription (Make, $11 to $16 USD a month depending on billing) is your own cost, kept separate: written out before starting, never discovered after.

Sources

• Claveau J., Authier M., Rodrigues I., Crevier-Tousignant M. "Patients' missed appointments in academic family practices in Quebec," Canadian Family Physician, 2020;66(5):349-355. pmc.ncbi.nlm.nih.gov/articles/PMC7219803
• Cochrane, "Mobile phone messaging reminders for attendance at healthcare appointments," Cochrane Database of Systematic Reviews, 2013, CD007458. pubmed.ncbi.nlm.nih.gov/24310741
• Werner K. et al., "Behavioural economic interventions to reduce health care appointment non-attendance," BMC Health Services Research, 2023, 23:1136. doi.org/10.1186/s12913-023-10059-9
• Hallsworth M. et al., "Stating appointment costs in SMS reminders reduces missed hospital appointments," PLoS ONE, 2015, 10(9):e0137306. wrap.warwick.ac.uk/89139
• Berliner Senderey A. et al., "It's how you say it: Systematic A/B testing of digital messaging cut hospital no-show rates," PLOS ONE, 2020. journals.plos.org
• Geneva University Hospitals, randomized trial on day-before reminders by text or phone, BMC Health Services Research, 2013, 13:125. link.springer.com
• CMAJ News, "Part one of a series on no-shows," January 21, 2020. cmaj.ca/content/192/6/E149
• Wegrzyniak L. M. et al., The Angle Orthodontist, 2018;88(3):314-318. angle-orthodontist.kglmeridian.com
• Make, pricing page, accessed November 6, 2026. make.com/en/pricing