How To Virtually Eliminate No-Calls and No-Shows (or get pretty darn close to it) Using Tools That Cost Practically Nothing.

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No-Calls. No-Shows. Cancellations. 😲

Just reading that makes you shudder, doesn’t it? (I don’t know about you, but it also made me break out into a cold sweat too).

Just about every Doctor I’ve ever spoken with has told me that there is always a certain percentage of new patient leads that just won’t show up no matter what they do.

Even worse, when those same Doctors start running paid advertising campaigns to attract new patients, the problem tends to get worse because they see a sudden flood of new patients from their ads and figuring out how to manage the schedule effectively to eliminate no-calls/no-shows becomes next to impossible when their new patient volume increases by 2-3x overnight.

You and I both know, this suddenly becomes a big, massive, catastrophic deal (maybe I’m being a bit dramatic, but you get the point). Think about it, if new patients don’t show up to their appointments, you then start to experience huge opportunity costs because those time slots could have been used for existing patients, or for other new patients that would show up to their appointment.

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Super frustrating, isn’t it?


BUT… today’s your lucky day. The no-call/no-show suffering game can finally end, because I’m going to share with you the exact system I’ve used to bring my client’s no-call/no-show rates from sometimes north of 50%, down to 0-10%.

However, before we get into the details of my system, I want to explain first why people no-call/no-show in the first place, so you can understand why this is happening in the first place (context is key):

Reason #1: People Forget, and They're Distracted

We’ve all got busy lives nowadays, and we’re all pulled in about 25 directions at the same time. So when someone takes the time to schedule an appointment, they certainly intend on following through with it when they schedule. However, keeping their attention enough to remember details of that appointment several days from now is extremely challenging to do, especially in the world of digital marketing.

Reason #2: You're Scheduling New Patients More Than 7 Days Out

Time and time again, when I go through this exact metric with my clients who struggle with no-shows, the vast majority of new patients who schedule their first visit 7 days (or more) out from the time they schedule don’t show up to their appointments.

Reason #3: Your Patient Has No Idea How You Can Help Them, And You're Not Tuning In To Their "WII-FM" (what's in it for me)

Think about it – if you see a killer offer on a killer ad, and schedule an appointment, but have no idea how well that doctor can treat (insert pain condition here), then you’re never going to associate that specific doctor as a solution to your specific condition – and therefore, make it a whole lot easier to forget/skip that upcoming appointment.

Reason #4: Your Offer Sucks/Lacks Urgency

Ouch, this is a hard one to swallow personally. I’ve created campaigns in the past that performed flawlessly from a cost per lead perspective, but the leads were practically impossible to schedule – and the ones they did manage to schedule struggled to show up to their appointment after scheduling. Your offer MUST have a high perceived value, otherwise you might “high-five” yourself thinking you’re killing it after looking at your ad account, and then crying later on when you’re plagued with no-shows.

Reason #5: A Laundry List Of Other Possible Reasons (all of which I've personally heard)

  • Your schedule is limited, so the patient took a slot they weren’t sure they could make
  • The office location is hard to find, or the patient has to pay for parking
  • The patient’s friends/family/other doctor talked them out of seeing you
  • The patient couldn’t find transportation to the clinic
  • … the list goes on

So now that you’re familiar with the list of reasons why your patients no-show, did you notice something that was a consistent theme? Here, I’ll give you a (not so subtle) hint:

These problems are actually easy to fix!

Solution #1: If People Are Forgetful & Distracted, Remind Them Often & Give Them Clarity

Reminders, reminders, reminders. Most offices are guilty of not using multiple reminders (or even any at all) for their new patients appointments. Here is the reminder frequency that has made the biggest impact on improving the no-show rate:

  1. When the patient schedules the appointment, send them a personally addressed email with the office address, the date/time of their appointment, and your phone number just in case they need to reschedule. At the same time, send them a text message with the exact same information. (Bonus: send them a calendar invite with the exact same information, so they will get a notification on their smartphone right before their appointment time)
  2. 24 hours before the appointment, send them a reminder email detailing the same info that was in the first email, and also send them a text message with the same information as the first text message. Also, send an automated reminder call OR have a person on staff call them personally with a reminder call.
  3. Two hours before the appointment, send them one final reminder email AND a reminder text message, again both detailing the same information that was in the previous emails and text messages.

Implementing this solution brought one of my client’s no-show rate from 30-40%, down to less than 5% practically overnight!

Now I know that you’re probably thinking, “Who in the world has the available staffing hours to be able to do all of these reminders on top of their existing work?”

The Answer: 90% of this is done automatically, while being personalized to the patient, and done at scale.

Here are the tools that I use to do this:


  1. Calendly – you can connect Calendly to your scheduling calendar (you need to make a Google calendar for your appointments), and schedule all of your new patients through Calendly. You can schedule automated emails to the patient at specific intervals, and also Calendly will send a calendar invite to the patient, so they can get notifications on their phone (in lieu of Calendly, you can also use Acuity, or if you want to connect directly to the calendar on your EHR system, you can create reminders with a tool called remindercall.com).

  2. Zapier – if you’ve never heard of Zapier before, then you’re in for a treat. This tool is the single greatest tool I’ve ever used in the history of digital tools. Zapier makes it insanely easy to create automation sequences and workflows between different tools that usually don’t talk to each other. So by using Zapier, I can pull Calendly appointments into a Google Sheet, and then have Zapier simultaneously trigger a text message (through Callfire, Twilio, or Sendlane) that is personalized to the patient based on the fields in the Google Sheet, and then run a delay tool that delays the next message to go out 24 hours before the appointment date/time, and then another delay to go out 2 hours before the appointment time.

  3. Your Staff – yes, your staff still needs to make one reminder call to the patient 24 hours in advance, but I bet you’re probably already doing that anyways, so this is a wash.

(Shameless Plug: There’s obviously a tiny bit more that needs to be done for this system to work, so if you want to help you with copy and implementation of a system like this, you’d have to be one of my clients first 😉. If you’d like to see if we’re a good fit for each other, head to https://bookme.name/actionadagency and schedule a time for us to chat).

Solution 2: Don't Schedule a New Patient's First Appointment More Than 7 Days Out

I probably don’t need to elaborate here, do I? If you know that a new patient is likely going to no-show over 70% of the time if they are scheduled more than 7 days out, then simply don’t allow your schedule to ever go that far unless you absolutely must.

Now once your practice gets a bit busier, you might find that you’re always booking 7 days out – and therefore never able to see new patients due to your schedule always being booked. In that scenario (which is arguably a good problem to have), now it’s time to consider adding more staff to handle more volume, getting more efficient with your appointment time slots, or starting to do group based activities – like a group report of findings, versus 1 on 1. However, this segment is practically worthy of an additional article – so I will touch on practice efficiency/management in a later article.

Solution 3: Be Specific With Your Advertising, and Always Make Sure You're Tuning In To Their WII-FM

I should add a caveat to this solution first, because if your offer is absolutely irresistible, then you don’t need to get to crazy with targeting and specificity with copy. BUT, if you’re running with a strong offer AND still struggling, then it’s time to get hyper-specific with your ad campaign. For example, if you’re a patient with Neuropathy and are desperate for a solution, are you more likely to resonate with a general chronic pain new patient special,? Or would you remember & resonate an ad with a Neuropathy new patient special instead?


I run condition specific advertising for some of my clients, and it does a much better job at helping the patient see that particular Doctor as a solution to their specific condition, and if they see that Doctor as a solution to their specific needs, then the new patient is far more likely to take the entire process seriously.

Solution 4: If Your Offer Sucks, Then Make a Better Offer

Oof, I certainly learned my lesson here. Usually, if you have a bad offer, it will reflect poorly from the cost per lead perspective – and it’s easy to spot where the problems are, and also easy to fix. However, when you’ve got a great cost per lead BUT you’re still struggling with schedule rates and show up rates, this problem becomes increasingly more challenging to find and fix.

To make matters worse, a strong or weak offer is all based on perception – so it’s a bit subjective. However, I’ll give you one solid piece of advice that you can bet on: Never run a free consultation offer without adding something of perceived value to the offer.


I’ve got more than enough data to prove this: I tested free consultation campaigns with multiple Chiropractic clients over a 3 month period, and got over 800 leads across 7 different clients in 7 different states, all of which reported a 5-20% schedule rate, with a 40-70% no-show rate. The results were abysmal.

Yet, with a Dental client, I’ve also ran an Invisalign AND Dentures campaign that included a free consultation and a discount on eventual Invisalign aligners or Dentures (and other value I won’t mention because I don’t want to divulge all of my secrets)- and the client was practically swimming in a pool of money afterwards, Scrooge McDuck style.

When you think about it, though, it kind of makes sense. Every Doctor out there offers a free consultation, so why would the new patient have any sense of urgency to want to come in now when everyone else offers the same thing? AND, if the consultation is free, then the new patient doesn’t feel bad about skipping out because they think since there was no money lost or gained on either end, then skipping out on the appointment won’t harm the Doctor.

Solution 5: Don't Make Excuses For a Poor No-Show Rate

One of my personal favorite business books is “Extreme Ownership” by Jocko Willink. In a Nutshell, Extreme Ownership is a manual for how to take accountability for problems, and how to overcome them – and how to live a life without excuses.


From my perspective, I don’t care about the problem – I only care about the solution. If you have a bad no-call, no-show rate it is vital to get to the root cause of the problem and tackle it head on. I’ll be the first to admit – this isn’t going to be a walk in the park. You may have compounding problems that are disguising the root causes of the problem, or complacent staff. However, we can either give the excuses validity by accepting them as viable reasons why the no-show rate is bad, OR we can become hyper vigilant in doing whatever it takes to overcome this problem and tackle it head on. Just because the no-show rate is always bad, doesn’t mean it has to be accepted as a valid fact.


Sometimes the first problem that we need to solve is within ourselves. And no matter how much better the no-show rate gets, it can always get better – and we need to measure and improve until we get below a 10% no-show rate.


In Conclusion, we have many tools & solutions to resolve any no-call/no-show issues you’re experiencing (and I broadly touched on causes and solutions for improving your no-show rate – there still are many more causes and solutions that I didn’t discuss today), but not working on fixing this problem is (potentially) costing you tens of thousands of dollars each month in lost potential patient revenue. Opportunity costs are silent money drainers, but they can account for more revenue than what’s sitting in collections if you’re not careful.


Originally posted by me at: 3rd-party-data-targeting-facebook-never-ever-getting-back-carroll/