No-show fees in therapy practices in Switzerland: Legal situation and implementation for all professional groups

Swiss therapy practices across all professional groups – physiotherapy, osteopathy, occupational therapy, speech therapy, TCM, massage, psychotherapy, and coaching – are permitted to charge no-show fees. The prerequisite is always a transparent prior agreement (GTCs or intake declaration) and a proportionate fee. The most effective technical implementation is a credit card guarantee via pre-authorisation – an alternative solution is required for TWINT payers.

This guide summarises the Swiss legal situation, industry-specific characteristics, proportionate fee amounts, and the technical implementation for all therapy professions.

1. Legal Basis: CO Art. 160 et seq. and the Contract upon Booking an Appointment

In Switzerland, booking an appointment constitutes a contract – even without written confirmation, even with telephone bookings. The Swiss Code of Obligations (CO) permits two ways to obtain money in the event of a breach of contract:

Option 1 – Compensation for damages pursuant to CO Art. 97 et seq.: The practice must prove that the missed appointment led to actual financial loss – i.e., that the slot could not be filled otherwise and revenue was lost. This is cumbersome and hardly enforceable in practice.

Option 2 – Contractual penalty pursuant to CO Art. 160 et seq.: The practice agrees in advance on a fixed lump sum that becomes due in the event of non-performance – without proof of loss. Prerequisite: The rule must have been explicitly agreed upon and accepted during booking or intake. This is the standard approach for all therapy practices.

2. Proportionate Fee Amount: What Applies to Which Sector

The fee must be proportionate and reflect the actual loss. There is no statutory upper limit. As a rule of thumb: the more difficult it is to fill the slot at short notice, the higher the fee may be. In well-booked practices that can often fill vacancies, the full session price would be difficult to justify.

3. The No-Show Policy: What Must Be in the GTCs

A legally sound no-show policy contains three elements: the cancellation deadline (the latest time by which cancellation must occur), the fee amount (fixed lump sum or percentage), and the exception policy (family emergency, sudden illness). Optional but recommended: a goodwill policy for the first missed session.

Sample wording for GTCs or intake declaration: 'In the event of appointment cancellations less than 24 hours prior to the agreed treatment or unexcused non-attendance, a cancellation fee of EUR [Amount] will be charged. In the case of a proven emergency, the fee is waived. The first missed session remains free of charge.'

Important: The policy must be communicated and accepted before service provision. This can take place via GTC consent during online booking, in the intake declaration at the initial consultation, or in a separate written agreement. Verbal agreements are difficult to prove.

4. SPO Position and Goodwill: What the Patient Organisation Recommends

The Swiss Patient Organisation (SPO) considers no-show fees to be fundamentally permissible, but sets clear conditions: The fee must have been communicated at the time of booking, must not exceed the actual loss, and goodwill in the event of blameless cancellations is expressly recommended.

In practice, a two-stage response is recommended: First no-show – enquire politely whether everything is alright, no fee charged. From the second no-show – fee is charged, with clearly communicated reasoning. This strengthens the therapeutic relationship and significantly reduces complaints.

5. Technical Implementation: Pre-authorisation via Payrexx

The most effective technical solution is the credit card guarantee (pre-authorisation) during online booking: The patient stores credit card details without an amount being debited immediately. In the event of a no-show, you debit the agreed fee with a few clicks in the Payrexx Dashboard – no dunning procedure, no debt enforcement law required. Note: A reservation is only valid for a few days – for bookings made far in advance, pre-authorisation is only suitable shortly before the appointment or as an advance payment.

Payrexx supports pre-authorisation for Visa, Mastercard (debit and credit), Apple Pay, Google Pay, and Samsung Pay. TWINT does not support pre-authorisation – an alternative is required for TWINT payers.

6. TWINT Alternative: Advance Payment with Refund Option

For patients who wish to pay exclusively via TWINT, there is a pragmatic alternative to the credit card guarantee: The patient pays for the session in advance via a TWINT payment link. If they cancel in time (within the agreed period), you refund the full amount – you trigger refunds directly in the Payrexx Dashboard. If they do not appear, you retain the amount in accordance with the no-show policy.

This assumes that the no-show policy is clearly communicated in the booking confirmation: 'You pay for the session in advance. In the event of cancellation up to 24 hours prior, you are refunded immediately. In the event of late cancellation or a no-show, the cancellation fee applies.'

7. Industry-Specific Characteristics

Psychotherapy

Special ethical dimension: A no-show can be a symptom, not indifference. Goodwill policy particularly important. Introduce the credit card guarantee transparently in the intake declaration. More details in the guide 'No-Show Fees in Psychotherapy'.

Children (Occupational therapy, Speech therapy, Paediatric physiotherapy)

The parents are the contractual partners, not the children. The no-show policy must be agreed upon with the parents. In the case of late cancellations due to child illness, goodwill is particularly appropriate – a goodwill rule for the first 2–3 cancellations is recommended.

Practices recognised under KVG health insurance

No-show fees for services covered by mandatory health insurance are possible, but the fee cannot be billed via health insurance. Consultation with the professional association (Physioswiss, Ergotherapie Schweiz, Logopädie Schweiz) recommended.

8. Checklist: No-Show Policy for All Therapy Practices

• Formulate no-show policy: cancellation deadline, fee amount, exceptions, first-session-free-of-charge rule

• Integrate policy into GTCs or intake declaration, obtain written consent

• Set up pre-authorisation in the Payrexx Dashboard (Visa, Mastercard, Mobile Wallets)

• For TWINT payers: communicate advance payment with refund option as an alternative

• Adapt booking confirmation: always explicitly mention the no-show policy

• Record goodwill rule internally: when the fee is waived

• Observe initial implementation: how do patients react? Adapt policy if necessary

• Annual review: is the fee amount still proportionate and customary in the market?

Payrexx supports pre-authorisation for Visa, Mastercard, and Mobile Wallets across all plans including Free – no subscription required for the core function. In the event of a no-show, you debit the fee with a few clicks in the Dashboard. For TWINT payers: payment link before the session with refund option. Everything in one Dashboard, one payout.