Appointment deposit policy templates

A $[amount] booking deposit is required to reserve [covered appointment/service]. It is [applied to / released at] the attended appointment.

Check: Say clearly what the deposit secures and when it is applied. Disclose the deposit and its conditions before you collect it, and keep the version of the terms the client accepted.

A [__%] deposit based on the quoted total is due at booking. Your quote is $[amount], so today's deposit is $[amount]. It is credited to the final total when you attend. If scope or price changes, the deposit is recalculated as follows: [rule].

Check: Show the dollar amount, not only the percentage, so the total is clear and conspicuous before booking (FTC Act §5 fee-disclosure principle).

A $[amount] scheduling deposit reserves [time/practitioner/resource]. It does not guarantee that [treatment/service] is suitable or will be provided; that decision follows the separate assessment and consent process. If our professional advises the service should not proceed, the deposit will [refund / transfer / apply to an alternative only with your consent] within [timeframe].

Check: Keep clinical suitability and informed consent independent from payment. Do not pressure a patient to accept an alternative service to avoid losing a deposit. A deposit does not replace a self-pay patient's federal Good Faith Estimate rights under the No Surprises Act — verify whether you are a covered provider.

Your [deposit/booking] may be transferred once when you request a change at least [__] hours before the appointment. The replacement appointment must be booked within [__ days]. A second change, a change inside the notice window, or non-attendance results in [specific outcome].

Check: Define the rebooking deadline and what happens if no suitable time exists. A change the business initiates should never count against the client's one transfer.

Where a refund applies, it is returned to the original payment method within [__] business days. If we cannot refund the original method, we will [alternative].

Check: State a concrete refund timeframe. Some states set refund-timing or deposit rules for particular industries (e.g., CA health-studio contracts, Civ. Code §1812.80 et seq.) — verify for your situation.

A late cancellation (less than [24/48] hours) or a no-show may result in a [$___ flat fee / ___% of the booked service], charged under the terms you accepted at booking.

Check: Disclose the exact amount and trigger BEFORE booking. To charge a card on file you need the cardholder's prior agreement to store and charge the card (card-network stored-credential rules). Do not keep a deposit AND also charge the full service price — stacked recovery and disproportionate fees are attacked as unenforceable penalties under liquidated-damages law (e.g., CA Civ. Code §1671, NY case law). Some states cap or scrutinize forfeitures — verify for your situation.

For these specifically listed appointment types — [types] — a missed visit or late cancellation may result in [$___ / the disclosed deposit treatment] only when the policy was explained in advance and applicable law and payer rules permit it. We do not submit missed-appointment charges to insurance as though care occurred.

Check: You cannot bill a payer for a no-show as delivered care (no CPT service was performed). Medicaid beneficiaries generally cannot be charged missed-appointment fees (42 CFR §447.15); confirm your state plan.

Any missed-appointment charge that applies to Medicare patients is the same charge applied to all patients for the same missed appointment, is billed directly to the patient (not to Medicare), and reflects a reserved-but-unused appointment time rather than a covered service.

Check: CMS (MLN Matters MM5613 / Claims Processing Manual §30.3.13) permits charging Medicare beneficiaries for missed appointments only if you charge non-Medicare patients the same fee and do not bill Medicare. Verify current CMS guidance and any hospital-based exceptions (e.g., 42 CFR §489.22).

If [business/practice name] cancels or reschedules your appointment, you may choose [a full refund / a transfer / your choice] within [timeframe], and any courtesy-transfer limit does not apply.

Check: Make the business-cancelled outcome as clear as the client-cancelled outcome. A one-sided policy is more exposed under unfair-practice principles.

This policy is shown before your appointment is confirmed. By booking, you acknowledge the notice window, any fee or deposit, and the refund and transfer terms above. A copy is available at [link] and on request.

Check: Disclose the full policy clearly and conspicuously before booking is finalized or a card is authorized, capture acceptance, and preserve the accepted version (FTC Act §5; card-network disclosure rules). Avoid changing terms after someone books.