Templates · Free template · Policies
Cancellation and No-Show Policy Agreement Template
A printable policy agreement clients sign at booking, stating the notice period, the late-cancellation and no-show fees, how deposits are handled, and the exceptions you will make.
A policy only works if it was agreed to
A fee for no-shows is far easier to apply when the client agreed to it in writing beforehand. The agreement should state the notice required, what happens if it is not given, and how deposits and prepaid packages are treated.
Add your exceptions, such as illness or emergency, in advance. Consistent, visible rules make enforcement feel fair rather than personal.
Cancellation and No-Show Policy Agreement
Client
Policy
Acknowledgement
Signatures
Template from zdrovia.ca/templates/cancellation-policy-agreement/ · Review with your medical director, regulatory college guidance, and insurer before use.
Send this form before the appointment instead of printing it
Zdrovia's form builder turns this template into a digital form your clients sign on their own phone. The signed copy files into their chart with the exact version they saw, and photo consent stays separate from treatment consent. It's free for solo practitioners, with data stored in Canada.
See how Zdrovia is set up for solo practices.
Frequently asked questions
How much should a no-show fee be?
Set it to reflect the lost appointment, and state it clearly. Many clinics charge a portion of the service price.
Are deposits better than fees?
Deposits are collected up front and remove the need to chase. Our booking deposit guide covers when to use each.
Related
This template is a starting point for discussion with your team and advisors, not legal or medical advice. Requirements vary by province and profession. Have your medical director, your regulatory college's guidance, and your malpractice insurer confirm the wording before you use it with patients.