Are Your Patient No-Show Strategies Robbing You Blind?

Dentistry Today


“Time is the coin of your life. It is the only coin you have, and you only can determine how it will be spent. Be careful lest you let other people spend it for you.” Carl Sandburg

How many times in the past few months have you run across articles in dental journals that promise, absolutely and positively, to help you get and keep new patients? How many of these say that the right script is the answer, or that the front desk person has to be smiling, welcoming, and of course, competent? These types of articles abound and, while I am drawn to them, I am always left feeling they haven’t taught me anything I did not already know. It is a bit like a tasty and appealing Chinese meal that initially fills me up, but leaves me hungry an hour later. No matter how attracted I was to the article, it didn’t seem to address the real problem. The problem in a nutshell is the following: “My marketing plan is really working well, and I have lots of new patients, but there is only one problem—most of them don’t show up!”

As you read on, you will see how we try to protect our office from the larceny that occurs when potential patients don’t show up. Our technique is not foolproof, but we lay out a strategy and a plan and that is much better than what most of us do, which is to expect all of our callers to be thoughtful people who always follow through exactly as they promise. You might try using our words, or creating your own script, but no matter what is done, there is one thing of which we are absolutely certain: without the courage to implement a no-show policy that includes monetary penalties you will continue to be an easy mark for those who would rob you. Perhaps this characterization is a bit harsh, but Carl Sandburg wouldn’t think so.

A call from a potential new patient is, in many ways, the most important activity that occurs in our office. It is the start of a relationship and, because we believe that relationships are the basis of our success, this call is the very foundation of our practice.

We suggest using this technique both literally (trying our exact words) and also tailoring it to the personalities and communication skills of staff. Nothing is worse than a script that is delivered by rote—it’s a certain prescription for turning the caller off. People want to talk to real people, not lifeless machines. Our process is sophisticated but will only work if injected with life and humanity. We suggest that you read what follows out loud, preferably at a staff meeting or staff retreat. That will expose the problems that staff (including the doctor) have with the policies that we are suggesting. It is not easy to implement, but it feels so much better not to get ripped-off. Invest the time and energy. You really will like the results.

The following outline, committed to memory, should be an essential skill-set for staff members who answer the phone:

  • Opening Line
  • Patient History
  • Purpose and Attitude
  • Referral
  • Follow-Through (Personal)
  • Follow-Through (Nonpersonal)
  • The Guarantee
  • The Reconfirmation

Opening Line 
RING, RING (never more than twice)

“Hello, thank you for calling Dr. _________’s office, this is _________.” Now pause. Almost always, folks will tell you their name after you have introduced yourself, if you leave enough time for that to happen. The most common error here is that we are way too speedy when we answer the phone. If you are at all unsure about the pronunciation or the spelling of a name, ask the caller for guidance. Please remember that the best way to mangle a relationship from the start is by either misspelling or mispronouncing a caller’s name.

Patient History
Establish whether this is a patient of record, or a potential new patient. This can be tricky. Sometimes it is awkward to ask the caller if they have previously been treated in your office, and some mechanism should be established to identify whether the caller is a patient of record. If the caller’s name is unfamiliar you might punch up the name into the computer at the beginning of the call. Sometimes, awkward as it might be, you just have to ask.

Purpose and Attitude
The call with the patient of record should be straightforward. Establish the purpose of the call. If there is a specific problem, identify it—area of pain or discomfort, the nature of the pain or sensitivity, how long this has been going on and so forth. Spend some time here—it is well worth it. The key here is to be empathetic. This is important since most times the folks that call us are in some discomfort. They rarely call to discuss the weather. The caller’s chart should be pulled while you are on the phone so that the conversation can be patient-specific. This conveys a powerful sense that you know and remember your patient. The caller should feel taken care of.

When a call comes in from a potential new patient, a good staff person will be excited by this new call, filled with adrenaline, and tempered with skill. After all, this staff person is now responsible for the growth of the practice and we are depending on them to perform. This call is all about possibilities. The new patient script must begin with these questions.

  • “Whom might we thank for the referral?” or
  • “How did you hear about our office?”

This question is logical, but often times a caller who is rushing or in pain may not want to hear your question. Don’t be deterred; it is an essential question and must be asked at this time. We are operating in the dark without this information. But worse than that, in the absence of this question and the ones that will follow we are abdicating our leadership in the conversation. You are the leader of this conversation, not the caller. People who ask questions are in control, a valuable pearl in all interactions.

Callers will generally give you one of 3 responses:
1. The name of a patient of record—in other words, an internal or personal referral)
2. A specific advertisement, the yellow pages, or some external source—in other words, a nonpersonal referral. At this point we might also ask, “What was it about the advertisement that attracted you?” This is a good way to start a conversation with someone you are meeting for the first time. It is an engaging question.
3. A source somewhere between the 2 categories. “I can’t remember who told me,” the caller may say, “Dr. _______’s name up came in conversation and I heard your office was fantastic.” Treat this as a nonpersonal referral even though the person might have some connection to the practice. It is too vague to be reliable.

The mindset for 2 or 3—the nonpersonal (external) referral—is that you should be warm and welcoming and yet realize that they are requesting entry into a terrific practice. This notion has to be shared by every staff member. We must find out if the caller qualifies for our practice. Not everyone will.

Follow-Through (Personal)
The personal referral conversation is fun and easy. The caller will tell you who made the referral, you will say something personal and positive about the referring patient, the caller will agree, and then you go to work on the details of the appointment date and time. Tell him or her to arrive 15 minutes early to fill out the paperwork (possibly it can be sent electronically or by regular mail).

Now you can go on with the details:

  • If the caller is in pain, see him or her immediately (same day).
  • Get the address (for city dwellers, remember the apartment number will be necessary for delivery), and of course, the Zip code.
  • Get all phone numbers: business, home, and cell.
  • Be sure to request an email address.
    (Repeat all of this information back to the new patient.)
  • We have developed a routine after this personal referral call. We send a “new patient” letter to the caller, followed by a thank-you call to the patient who made the referral. In our office, the doctor makes the thank-you call. It is expresses our sincere appreciation for our patient’s recommendation.

In my office these calls go something like this: “Hello, Mary, this is Dr. Goldstein (or Alan). I wanted to thank you for referring Bob to our office; he just called and will be coming in next week. Thanks! Also, and of course without violating any confidences, I want to ask if there is anything you know about Bob that would help us be more welcoming to him—you know, maybe he is super-nervous or there are cosmetic issues. Again I don’t want to cross the confidentiality line, but we want to be really welcoming for Bob.” (I leave a lot of space for a response here.) “Okay, thanks, Mary—and I’ll be seeing you in 3 weeks for your regular checkup!”

In service firms such as ours, any real human contact, any personal touch supports and deepens the relationship. Nothing is more valuable.

Follow-Through (Nonpersonal)
The work with the nonpersonal referral is more challenging. It involves the same details as that of the personal referral, except that we don’t know if the caller qualifies for our practice. To use sales language: the notion of a qualified buyer is central to the successful sales process. Everyone would like a BMW, but not everyone qualifies as a BMW buyer.

We have a simple way of qualifying potential patients: 
“We require 2 full business days notice, excluding weekends and evenings, for any change or cancellation of this appointment.” 

This is stressed and may even be embellished by talking about the fabulous on-time record of the office. This is a good marker for a terrific staff person since it directly relates to the level of his or her pride for the practice.

This is a successful method that weeds out the price-based patients. (The “shoppers” are probably not the folks you are most interested in seeking.) We will give fees for a consultation or a new patient visit but will not give fees for any other service. Over the years, we have learned that the “How much is a crown?” patient is wrong for our practice. Quality and service are our trademarks, and our long-standing patients tell us that they feel we are well-valued.
After talking about the cancellation policy the front desk person says, 
“Which credit card would you like to use to guarantee this appointment?” (Don’t forget to ask for the expiration date of the credit card.)

The Guarantee
We do not give appointments to nonpersonal referrals without a credit card guarantee. The reason for this is straightforward. We have found that callers who found us in the yellow pages and the Internet are far less reliable than those who are personally referred. This is not a moral judgment but rather based on our experience during years of practice. We cannot afford the possibility of a lost hour of chair time. The credit card guarantee almost assures us that the person will show up or give us the proper notice for cancellation.

In this day and age the notion of a guarantee is not unusual and your request won’t come as a great surprise. Nonetheless this part of the call requires practice to actually own the language and business perspective that it embodies. A predictable schedule is the basis of a successful and profitable office, and everyone on staff takes patient reliability personally. It is a big deal when a new patient doesn’t show up. When a staff member has played an active role in generating a qualified patient it truly empowers everyone in the office. This guarantee will also reassure the sophisticated dental patient, who will appreciate that we are an on-time office that respects each patient’s valuable time.

The Reconfirmation
Next you say, “I want to reconfirm your address because I’m sending you a letter [or e-mail] that tells you about our office, a bit about each member of our staff, and a description of the various kinds of technology we employ.” (This is an important sentence since it conveys a commitment to modern and patient-friendly dentistry.) “I look forward to meeting you on ______ at _______am/pm.”

These are the last words that our new patient should hear. The conversation should leave both parties feeling excited about meeting each other in the office. We have, in fact, started a new relationship. 
For our part, and not unlike a blind date that our Aunt Sadie has arranged, we make sure our shoes are shined, our clothes pressed, hair is neat and combed, and of course the office is spic and span. Will we like this person? Will they like us? Will we have a future? 
Sorry, I have to run now—there is someone at the door.

Dr. Goldstein is a 1968 graduate of the University of Pennsylvania School of Dental Medicine. He is the immediate past president of the Academy of Laser Dentistry as well as a certified professional coach. He received his certification credential from New Ventures West after taking its one-year professional coaching course. Dr. Goldstein is a Fellow in the American College of Dentists and serves on the Dental Advisory Board of Dentistry Today. Dr. Goldstein maintains a general practice dental practice in New York City and is one of the founding members of the Dental Coaches Association, a newly formed group of certified coaches ( He can be reached via e-mail at or by visiting the Web site


Disclosure: Dr. Goldstein reports no conflicts of interest.