How to Prevent No-Shows

How to Prevent No-Shows

How to Prevent No-Shows

How to Prevent no-shows

His frustration had reached the boiling point. After three no-shows this week, a veterinarian asked me if he should start asking clients to prepay for surgeries. While I empathize with his angst, don’t punish 99.9 percent of good clients for a few bad apples. Imagine you are a client of 12 years who now has to pay before services get delivered. You might get so mad that you leave the practice. Instead, use these proactive techniques to prevent no-shows:

Text or email appointment confirmations immediately after booking.

A client schedules a spay one month from today during her puppy’s last checkup. If you wait until the day before the procedure to remind her of the surgery and fasting instructions, you chance that she may forget or need to reschedule. When she books today, immediately text or email an appointment confirmation that she may add to her calendar. Set up appointment confirmations in your practice-management software or third-party apps. Text: “<Pet name> has a surgical admission appt on <date> at <time>. Reply C to confirm or RS to reschedule.” If a client replies RS, call to have her select a new time and date.  

This double confirmation at the time of booking reiterates the importance of the exam or procedure. My dentist does this. When I booked my next hygiene appointment, I got a text on the elevator ride to the parking garage. I added the appointment to my calendar before I unlocked my car.

Confirm earlier and multiple times. 

Don’t wait until the day before appointments or procedures to remind clients. Set up a series of confirmations and reminders: 1) Upon booking, 2) Four days before the appointment or procedure, 3) Two days ahead, and 4) The day of the appointment, reminding of fasting instructions for procedures or bringing stool samples for checkups. 

Gather new client information during scheduling calls. 

Go beyond collecting a name and phone number. When scheduling, take 2 minutes to enter the client and patient names, address, email, cell number, and patient breed and birthdate. You’ll avoid the negative experience of “clip-boarding” a new client when you hand her a registration form at check-in while she struggles with her Jack Russell terrorist on a retractable leash. You’ll suck away valuable exam time with busy paperwork. Because you have gathered the majority of client contact information during the scheduling call, you’ve established a “know, like, and trust” relationship. 

Perform preanesthetic testing when clients book procedures. 

If you diagnose my cat with dental disease on Wednesday and I schedule treatment for Friday, collect blood and urine samples for preanesthetic screening today. This lets you choose the most cost-effective diagnostics from the reference lab or in-house testing. The client pays for lab tests today, reassuring she will show up two days later for the procedure. Your nursing team also will appreciate one less task to perform the morning of the dental treatment. 

Have clients sign anesthetic and surgical consents before booking. 

Let’s say you diagnose dental disease and explain the need for treatment. The client agrees. Get signatures on the treatment plan and anesthetic consent form today. You’ll dodge the time-suck of paperwork and get written commitment to show up. 

An alternative is use text and email together. When you confirm the surgery two days in advance, text the client: “See you Friday at 8 a.m. for <pet name>’s surgical admission. No food after 10 p.m. Water is OK. We emailed surgical forms to <email>. Reply with questions.” The text prompts the client to check her email, where you can provide detailed fasting instructions and attach consent forms and treatment plans.

Your email message would say, “We will see <pet name> for surgery on Friday at <Your Veterinary Hospital>. Please withhold food after 10 p.m. tonight. Water is OK to drink to prevent dehydration. Your surgical admission begins at 8 a.m. with a nurse, who will spend 15 minutes reviewing the consent form, answering your questions, and getting phone numbers where we may reach you the day of the procedure. I’ve attached your treatment plan and anesthesia consent forms. To speed your admission, please bring these signed forms with you, or we are happy to answer questions during check-in. Please allow at least 15 minutes for <pet name>’s admission to our hospital. If you have questions, call or text 555-555-5555.” 

Text driving directions to new clients. 

When you confirm exams two days in advance, text: “We’re excited to meet you and <pet name> on Friday at 4 p.m. Bring a stool sample that’s fresh within 4 hours. Get driving directions at <link>.” When new clients click the link on their smartphones, map apps will give them estimated travel time along with turn-by-turn directions. You’ll enjoy on-time arrivals and create “wow” first impressions. 

Send a final text or email confirmation the day before appointments and procedures. 

Text the client: “We will see <pet name> tomorrow for an appt with Dr. <Name> beginning at 9 a.m.” The word “beginning” trains the client to be in your lobby at exam time, not down the street at Starbucks (unless she’s fetching you a pumpkin spice latte!). 

Mail thank-you cards after the first visit. 

This is the first date that starts a lifetime relationship. Don’t default to a templated email or text that will get scanned and deleted. People receive hand-written greeting cards in the mail on birthdays, holidays, or anniversaries. Make the new client appointment a standout occasion. Have the doctor and hospital manager sign the card and add a personal message such as “We loved meeting your kitten, <pet name>, and look forward to watching him grow up!”

Start no-show strategies today.

A dog owner may spend nearly $700 for a checkup that includes an exam, vaccines, diagnostics, and 12 months of flea/tick and heartworm preventatives. Surgical and dental procedures may have even higher dollar values to your practice. Stop the anxiety of whether clients will show up as promised. Reclaim the confidence that you’ll have long-term, loyal relationships with these approaches.

Author: Wendy S. Myers, CVJ, Communication Solutions for Veterinarians


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Avoid a Meltdown When Dr. Popular Isn’t Available

Avoid a Meltdown When Dr. Popular Isn’t Available

Avoid a Meltdown When Dr. Popular Isn’t Available

A longtime client calls and requests an appointment with Dr. Popular. While this veterinarian is blessed to be busy, you don’t want clients to have meltdowns when they can’t see their preferred doctor. What should you do? 


focus on what you can do.

Don’t tell the pet owner that the doctor is booked three weeks out because it will create a negative impression and could incite an argument. Say, “Dr. Popular’s next available appointment is Aug. 30 at 9 a.m. If your pet needs to be seen sooner, Dr. Next could see you tomorrow at 4 p.m. Which do you prefer?” 

practice forward booking.

When clients want their first choice of time, day, and doctor, have them book the next appointment during today’s exam. Use forward booking for progress exams, checkups, and disease-management exams for pets with chronic health conditions.  

When wrapping up today’s exam, Dr. Popular should introduce the concept of forward booking. If you have computers in exams rooms, he should schedule it now (Yes, the veterinarian needs to know how to use the scheduling tool in your practice-management software). Here are two examples of client conversations: 

For a disease-management exam, explain the “why” behind the change in the frequency of exams and use benefit statements. Dr. Popular would say, “Because Molly was diagnosed with arthritis today and will begin long-term medication, I will need to see her every six months to manage her arthritis and check blood work in case we need to adjust medication dosages. Booking her next exam now will let you get your first choice of a time and date with me. Six months from today would be Jan. 9. I could see Molly at 10 a.m. or 4 p.m. Which do you prefer?” 

For a checkup, lead the client to book the next six- or 12-month exam. If the receptionist is scheduling the exam during checkout, she would say, “Just as your dentist has you schedule your next appointment at checkout, we do the same to proactively manage your pet’s health. Let’s book your pet’s next checkup for this same day and time next year. We will confirm two weeks before the exam, so if you need to change the appointment it will be easy. By scheduling today, you will get your first choice with Dr. Popular. He could see your pet at 10 a.m. on Wednesday, Aug. 12 or 3 p.m. on Friday, Aug. 14. Which do you prefer?” The first choice is the same day of the week and time as today’s appointment. The second choice is a different day of the week and time of day (morning vs. afternoon). Get scheduling techniques in my article on “Four Ways to Use Forward Booking” (https://www.veterinarypracticenews.com/four-ways-to-use-forward-booking/).   

be persistent when pets require progress exams.

Because Dr. Popular is booking weeks in advance, the entire healthcare team must be dogged and communicate the importance of scheduling follow-up care today. After explaining how to clean a dog’s ears and apply ointment for an ear infection, the nurse would say, “Dr. Popular needs to perform a follow-up exam in two weeks for your dog’s ear infection. We strive to book follow-up care with the same doctor because Dr. Popular wants to see the condition successfully resolved. This will be a 15-minute appointment to examine your dog’s ears and determine if additional treatment will be needed. Dr. Popular could see your dog on Thursday, Aug. 28 at 10 a.m. or Friday, Aug. 29 at 2 p.m. Which do you prefer?” 

If the client procrastinates and waits to call your hospital in two weeks when care is due, Dr. Popular won’t be available. Booking with the same veterinarian helps you achieve exam efficiency. If Dr. Next will see Dr. Popular’s patient for follow-up care, he will need to spend more time reviewing the medical record to get up-to-date on the diagnosis, treatment, and prescribed medications. The follow-up visit may take twice as long if a different doctor sees the patient.  

add more urgent care slots to dr. popular’s schedule.  

I advise receptionists to block three urgent-care slots per doctor per day for same-day sick patients. Because clients will call every morning with sick patients that must be seen today, plan for them in your daily schedule. You may need more urgent care slots on Mondays, Fridays, and Saturdays, when hospitals typically see higher volumes of sick patients.  

To determine how many urgent care slots Dr. Popular will need, create a spreadsheet that totals the number of exams he sees by day of the week. Let’s say he saw 22 patients on Thursday. Approximately 20 percent of patients are same-day sick appointments. Based on this formula, Dr. Popular would need seven urgent-care slots on Thursdays. Block an urgent-care slot at the top of each hour in Dr. Popular’s schedule on Thursdays. Get more insight in my YouTube video on “Overbooked and Can’t See Sick Pets? Here’s the Solution” at https://www.youtube.com/watch?v=j_oWxml2qyc&t=9s.  

Talk up other doctors.  

You want clients to feel confident and comfortable with every doctor in your practice. Dr. Popular, nurses, and the client-care team need to praise the skills and knowledge of other veterinarians in your hospital. When a client sighs after hearing Dr. Popular isn’t immediately available, promote Dr. Next. The receptionist would say, “Dr. Popular’s next availability is Aug. 30 at 9 a.m. I could schedule you with Dr. Next. He has a special interest in feline medicine and would love to meet Alex. I’m confident you’ll be satisfied with the quality of his medicine. Dr. Next could see Alex tomorrow at 4 p.m. Shall I schedule this exam?”

During his appointments, Dr. Popular also can share praises of his colleague, Dr. Next. Afterall, Dr. Popular may be the practice owner and hired Dr. Next. To transfer the client’s trust to another veterinarian, Dr. Popular might say, “Dr. Next has been part of my medical team for five years. We went to the same veterinary college and share similar medical interests and philosophies. If I’m unable to promptly see your pet, I’m confident that Dr. Next will do an exceptional job.” 

Because Dr. Popular will take vacations or may sell the practice one day, you must build trust in every veterinarian. Have your team discuss ways to equally distribute appointments amongst all doctors because the hospital’s goal is to have every veterinarian fully booked every day.


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4 Ways to Use Forward Booking

4 Ways to Use Forward Booking

4 Ways to Use Forward Booking

Is your team struggling with forward booking? Only 5 percent of veterinarians use forward booking compared to 80 percent of dentists. (*1) Besides providing timely patient care, forward booking can dramatically improve your bottom line. Increasing to 10 percent of forward-booked exams would increase annual revenue $40,000 for a typical veterinary hospital. Here’s how to use forward booking for four appointment types:

1. Medical progress exams

Veterinarians excel in this category. A Veterinary Hospital Managers Association Insider Insights Report found 76 percent of teams schedule progress exams. (*2) Tell clients when their pets need to be seen next, avoiding the yes-or-no choice of “Do you want to schedule your next appointment.” Follow the guidelines of “same day, same time, same doctor.”

Seeing the same veterinarian builds client confidence that the medical problem will be resolved and provides exam efficiency. If a different doctor sees the patient for follow up, he may spend twice the amount of time reviewing the medical record to learn the previous veterinarian’s diagnosis and treatment. Tell the client, “Dr. Smith needs to see your dog in two weeks for a medical progress exam for Duke’s ear infection. Does this same time, 9 a.m. on Oct. 25, fit your schedule?”

Select from three approaches to schedule care now:


Choice 1:

If you have computers in exam rooms, book follow-up care now. You risk having the client walk through the “mind-erase hallway” on the way to the front desk to check out. Because the client is focused on leaving, he forgets to schedule. The receptionist may not know that follow-up care is necessary unless she reads the diagnosis in the medical record.

Choice 2:

Put an alert in your software or use a travel sheet. This notifies receptionists to schedule medical progress exams before checking out clients for today’s services.

Choice 3:

Do a verbal handoff. The doctor or technician walks the client to the checkout counter and tells the receptionist, “We need to see Duke again in two weeks for a progress exam for an ear infection. Could you please schedule that with Dr. Smith?”

Avoid the term “recheck,” which clients may perceive as free and optional. “Medical progress exam” clearly communicates you’re following up on a previously diagnosed condition. Update this term in your practice-management software.


2. Procedures

Give clients information to decide on treatment on the day of diagnosis. After the veterinarian explains his diagnosis and your anesthetic protocols, answer the client’s questions. Have a technician present a treatment plan that lists medical services and fees. The technician would tell the client, “Now that Dr. Smith has answered your questions, he asked me to go through the treatment plan with you, so you understand the specific services and fees. I will show you photos of a pet’s dental procedure that illustrates each of the steps. I can share information about our payment plans through <third-party financing>. Then you can decide how you want us to proceed.” After reviewing the treatment plan, ask for a commitment: “Shall we schedule your pet’s procedure?” Lead the client to book now with the two-yes-options technique: “We can perform the dental procedure on Monday or Wednesday. Which do you prefer?”

Busy practices may have full surgical and dental schedules for two or more weeks. If clients don’t schedule elective procedures on the day of diagnosis, you may have limited availability that cause them to seek faster care elsewhere. Focus on what you can do, not what you can’t. Say, “Dr. Smith’s next available surgery days are Oct. 23 and 24. Which do you prefer?”

3. Disease-management exams

Create categories of exams to distinguish reminders and fees. Use pediatric, adult and senior preventive exam codes for routine checkups. When a pet is diagnosed with a chronic health condition, change the preventive exam code to a disease-management exam. Forward booking will let the veterinarian provide optimal disease management. Clients also will appreciate that the veterinarian has spread out the cost of care.

Set the reminder interval based on the frequency of follow-up care. Let’s say you diagnose a dog with arthritis and prescribe a non-steroidal anti-inflammatory drug and therapeutic diet. You want to see the patient every six months for exams and drug monitoring tests.

After explaining the diagnosis and answering the client’s questions, tell her, “Because Daisy was diagnosed with arthritis today and will begin long-term medication, I need to see her every six months to successfully manage her arthritis and check blood work in case we need to adjust medication dosages. Six months from today would be March 16. I could see Daisy at 9 a.m. or 3 p.m. Which do you prefer?” Explain the “why” behind the change in frequency of exams and use benefit statements.


4. Preventive checkups

Six out of 10 pet owners will forward book their pets’ checkups.1 Use a comparison that clients already understand: Dentists. Say, “Just as your dentist has you schedule your next appointment at checkout, we do the same to proactively manage your pet’s health. Dr. Smith could see your pet at 10 a.m. on Wednesday, March 14 or 3 p.m. on Friday, March 16. Which do you prefer?” The first choice is the same day of the week and time as today’s appointment. The second choice is a different day of the week and time of day (morning vs. afternoon).

When a procrastinator won’t book, be persistent and use benefit statements. Say, “I understand you don’t know your schedule 12 months from today. Let’s book your pet’s next checkup for this same day and time next year. We will confirm two weeks before the exam, so if you need to change the appointment it will be easy. By scheduling today, you will get your first choice of doctor, day and time. Your appointment reminder for 10 a.m., Wednesday, March 14 will print on today’s receipt.”

Color code your schedule to identify which appointments were forward booked. Confirm these exams two weeks in advance in case clients need to reschedule. Use text and email confirmation for efficiency. If clients have not responded to electronic notices, call them four days before forward-booked exams to confirm.

You will need to have doctors’ schedules in your software for 12 months in the future. Don’t worry if work schedules change due to veterinarians’ conference attendance or vacations. Doctors will often request time off one or more months in advance, especially when buying plane tickets and registering for conferences in advance. Because you’ll confirm forward-booked exams two weeks ahead, you can easily move appointments. Call the client and say, “Dr. Smith asked me to call you to reschedule Daisy’s disease-management exam on March 16 because he will be out of the office. Can the doctor see Daisy at the same time, 10 a.m. on Wednesday, March 21, which is just one week later?”


Forward booking doesn’t fall on the shoulders of receptionists alone.

Doctors, technicians and receptionists must support one another’s efforts to secure follow-up care. Clients need to hear a consistent message that you’re working together as a team to proactively manage their pets’ health.


*1 – AAHA State of the Industry Report 2015. Accessed Aug. 17, 2018 at www.aaha.org/graphics/original/professional/resources/library/aaha_state_of_the_industry_2015.pdf.

*2 –  Felsted K, Gavzer, K. Forward Booking Appointments: How to Fill Your Appointment Schedule. Partners for Healthy Pets, 2015:6,4. Accessed Aug. 17, 2018 at www.partnersforhealthypets.org/forward_booking.aspx.

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