Clinic no-show policy in Singapore, with reminders, deposits and payment at booking

A Singapore clinic reduces no-shows by sending more than one reminder, making it easy to move a visit by message, and taking a deposit or the fee when the patient books. The policy should be written down, stated at booking and applied the same way to every patient.

The problem is measurable in Singapore. At one hospital's outpatient MRI service, 17.4% of 32,957 appointments were missed, and phone reminders aimed at the quarter of patients most likely to miss reduced the no-show rate from 19.3% to 15.9% within six months.¹

How common no-shows are

A review of 105 studies in Health Policy put the average no-show rate at about 23%. The most commonly reported predictors were a long gap between booking and appointment and a history of previous no-shows.²

Those two predictors point to the practical levers. Keep the time between booking and visit short where you can, and give more attention to patients who have missed before, such as a personal call when they have not confirmed.

Reminders

A Cochrane review of eight randomised trials with 6,615 participants found that attendance was 67.8% with no reminder, 78.6% with text message reminders and 80.3% with phone reminders. Texts and calls had a similar effect, and two studies found the cost per attendance was 55% and 65% lower for texts.³

A meta-analysis of 26 studies in BMJ Open found that patients who received digital notifications were 25% less likely to miss their appointment, 15% against 21%. Multiple notifications improved attendance more than a single notification.⁴

Write reminders in the language the patient uses with the clinic. In the 2020 census, 48.3% of residents aged five and over spoke English most often at home and 29.9% Mandarin.⁵ Write the reply that confirms or moves the visit in the same language.

Confirm by message as soon as the visit is booked, with the time, the address and the policy.
Remind two or three days before, with a simple way to confirm or move the visit.
Remind on the morning of the visit.
Call patients who have missed before and have not confirmed.

Use what the clinic already knows

The Singapore MRI study used past appointment data to predict which patients were most likely to miss, and called only the top quarter. The model was moderately accurate, and the no-show rate among high-risk patients the team could not reach was 40.3%, against 17.5% among those it could.¹ A clinic does not need a model to act on that finding. Keep phone numbers current, confirm them at every visit, and call the patients who have missed before.

Deposits and payment at booking

Reminders help the patient who forgets. A deposit or full payment at booking also protects the clinic when a patient decides late not to come, because the time is paid for. The trials cited here studied reminders, so measure your own no-show rate before and after you introduce a deposit.

Set the amount and when it is taken, at booking or a set number of days before the visit.
State how much notice the patient must give to move or cancel without losing it.
Say whether the deposit is credited to the visit fee.
Apply the policy the same way to every patient, and record each exception and the reason.
Show the policy at booking, in the confirmation and in the reminder.

How to word the policy

Write the policy as a courtesy to the patient. Say what is taken, when, and how to move the visit in one message. For example, a deposit is taken when you book and is credited to your visit, and if you need to change your appointment, please let us know at least 24 hours ahead and we will move it for you.

If fees and deposits appear on your website, MOH's advertising guidance requires exact figures without prefixes, and it does not allow an instalment amount to be shown without the total price.⁶

Make it easy to cancel

A patient who cannot come is more useful to the clinic if they say so early. Every reminder should let the patient move or cancel by replying, without a phone call, and the released slot should go back into the booking page straight away. Record the reason for each cancellation or missed visit from a short fixed list, such as forgot, unwell, transport, cost or work, so the clinic can see which reasons a change of policy would affect.

Patients who miss repeatedly

A history of previous no-shows is one of the most commonly reported predictors of the next one.² Talk to a patient who has missed twice before the third booking. Ask what would make attending easier, such as a different time of day, a reminder to a family member who helps with appointments, or a remote consultation where that is clinically suitable. Then apply the deposit policy as written.

Measure it

Track the no-show rate each week by service, by doctor and by how far ahead the visit was booked. Because a long gap between booking and appointment is one of the most commonly reported predictors, look first at visits booked weeks ahead.² If their rate stays high, add a reminder or shorten the booking window for that service.

What wai Admin and wai Profile do

wai Admin takes the deposit or the full fee at booking, sends confirmations and reminders, and handles rebooking by message in English and Mandarin. wai Profile lets the patient see the visit, pay and check in from their phone. The change for the clinic is a diary where a missed visit is either paid for or rebooked.

Questions

What is a typical no-show rate for clinics?

A review of 105 studies put the average at about 23%, with wide variation by region and setting.² One Singapore hospital's outpatient MRI service recorded 17.4% across 32,957 appointments.¹

Do appointment reminders reduce no-shows?

Yes. A meta-analysis found that patients who received digital notifications missed 15% of appointments against 21% for those who did not.⁴

Is a text reminder as effective as a phone call?

A Cochrane review found text and phone reminders had a similar effect on attendance. Two of the included studies found texts cost 55% and 65% less per attendance than calls.³

How many reminders should a clinic send?

More than one. A meta-analysis found that multiple notifications improved attendance more than a single notification.⁴

Sources

Written and reviewed by the clinical team at wai. Last reviewed 17 September 2026.