Process improvement for behavioral health

Remind Clients About Appointments


Clients miss assessment appointments and treatment sessions because they forget about appointments.


Call clients 24-48 hours in advance to remind them about their next appointment.

Featured Stories

CAB Health and Recovery in Peabody, Massachusetts reduced no-show rates to intake appointments by 27 percent and increased participation rates for patients continuing from assessment to their first appointment by 23 percent. They had the evening staff make reminder phone calls during periods of lower volume and when clients were more likely to be at home to receive the call. For more information, see the case study.

Racine Psychological Services in Racine, Wisconsin increased the attendance rate from 47 percent in August 2005 to 72 percent in January 2006 by asking outpatients if they wanted to be reminded about their appointments by phone. If so, they asked what phone number to call and whether it was OK to leave a message. A customer-friendly person made the reminder calls.

Lessons Learned

  • Ask clients if they would like to receive a reminder call in advance.
  • Make reminder calls when you’re most likely to reach the client—e.g., late afternoon or early evening.
  • Use text messages to remind adolescents and young adults.
  • Caution: Some NIATx providers have found that making reminder phone calls actually resulted in higher no-show rates, so be sure to test this promising practice on a small scale and refine it so that it works at your site. There are a number of reasons that reminder calls may not decrease no-shows:
    • Having the wrong person make the reminder call. A case manager or counselor may be better prepared to address issues that come up than a receptionist.
    • Not being able to reach clients because they don’t have phones.
    • Not leaving a message to maintain confidentiality if the client didn’t answer.
    • Sending postcards or letters rather than making phone calls. If you have time to send a letter, revisit the promising practices for reducing waiting time.
  • If you decide to make reminder calls for the first face-to-face session and also subsequent sessions, implement the changes as two separate Change Projects, focusing on two separate aims:
    1. Reduce no-shows to assessment appointment
    2. Increase continuation during treatment.

This approach will make it easier to determine what kind of reminder call works best for a client who has never been to your agency as opposed to a client who is returning. The type of conversation is likely to be different.

For assessment appointments:

  • Have counselors who will be doing the assessments make the reminder calls so they can begin to establish a therapeutic relationship with the client.
  • Remind clients about appointments 48 hours in advance, so that if they need to reschedule or cancel, there is enough time to schedule someone else.
  • Keep a list of clients willing to come in sooner, in the event that there’s a cancellation; or offer canceled appointments to incoming callers.
  • Find out with whom you can leave a reminder message if the client does not have a phone.
  • Use the reminder call as an opportunity to ask clients if they have questions or concerns, logistical problems, or other problems that might prevent them from coming to the appointment.
  • Use the reminder call to help overcome the client’s reluctance to come in the first time and provide an opportunity to establish a connection before you meet in person.

For ongoing treatment sessions:

  • Remind clients about appointments for individual and group treatment sessions.
  • To minimize the time required to make reminder calls, make reminder calls only to clients who have missed appointments in the past.
  • Determine at what point clients most often drop out of treatment—for example, between the first and second treatment session, etc.—and make reminder calls to clients that are at that stage of treatment.

Tracking Measures

Cycle Measure

No-show rate for assessment appointments or treatment sessions

Data Collection Form

No-show Tracking Spreadsheet



  • 1. Select the service activity for which you will be making reminder calls—for example, assessment appointments, group sessions, or one counselor’s individual sessions.
  • 2. Identify the staff person who will be responsible for making reminder calls.
  • 3. Develop a simple script for this person to use when making reminder calls.
  • 4. Collect baseline data for the no-show rate for this type of appointment, without reminder calls.


  • 5. For the next forty clients or the next two weeks, whichever happens first, ask clients in advance whether they want a reminder call and whether you have their permission to leave a message.
  • 6. Make reminder calls to the clients that wanted them and keep track of whether you reached them, left a message, were unable to reach them, or had bad contact information.
  • 7. Track and calculate the no-show rate at the next appointment for clients who received a reminder call.


  • 8. Check the fidelity of the change. Was the change implemented as planned?
  • 9. Evaluate the change:
    • What percentage of the clients that you called did you actually reach?
    • Was it easier to reach clients at a particular time of day?
    • Did the no-show rate decrease when clients received reminder calls?


  • Adjust the script, the timing of the reminder calls, the person making the calls, or the way that you request reliable contact information and re-test this promising practice for an additional two weeks.

Repeat this series of steps until you are satisfied with the system for making reminder calls and so that all patients who need and want reminder calls are receiving them. Expand this practice to make reminder calls for other group or individual sessions for which there is a high no-show rate.

More Stories

Daybreak Youth Services in Spokane, Washington reduced no-shows from 22.2 percent to 15.4 percent over a period of 2 months by making reminder phone calls. One counselor, with the help of a secretary, began making reminder calls to all of her clients the day before their appointments. This counselor’s no-show rate showed quick improvement so the practice was expanded to all clinicians and sites. For more information, see the change bulletin.

MECCA in Des Moines, Iowa reduced no-shows by 44 percent by calling clients to remind them about their appointments.

Port Human Services in Greenville, North Carolina reduced no-shows by 50 percent by calling clients who missed a methadone dose to remind them to come in.