Across the accounts where we could measure it, 42% of booked consults showed — 48% on core injectables, 67% on a smaller secondary group, and 0% on an education offer. Show rate is attended divided by booked, for the same cohort of appointments. But three of five audited accounts couldn’t compute it at all: their calendars never mark showed or no-show, so every appointment sits at “confirmed” long past its start time. If that’s you, the benchmark isn’t your problem yet. A practice that can’t see past “booked” can’t tell whether its money worked.
What is a good show rate for a med spa?
Here is what we actually measured, from calendar records rather than a dashboard.
| Group | Booked | Showed | Show rate |
|---|---|---|---|
| Core | 52 | 25 | 48% |
| Secondary | 6 | 4 | 67% |
| Training | 11 | 0 | 0% |
| Total | 69 | 29 | 42% |
Two things in that table matter more than the headline number.
The first is the spread. Show rate is not an industry constant you inherit. It is the output of decisions you control — how the appointment was made, what was committed at the point of booking, and which way your reminder points.
The second is the training row. Eleven bookings, nobody attended. That offer looked fine on every report upstream of this table: it produced bookings at $156 against the core offer’s $124. Only a show column exposes it, and most clinics don’t have one.
How do you calculate show rate correctly?
The formula is trivial. The denominator is where clinics lose the plot.
Show rate = consults attended ÷ consults booked, where both refer to appointments scheduled to occur in the window, not appointments created in it. Book her on the 28th for the 4th of next month and she belongs to next month’s cohort. Mix the two and your number swings with booking volume rather than attendance.
- Cancellations stay in the denominator. A patient who cancels 24 hours out did not show. More polite than a no-show, and exactly as empty a chair.
- Reschedules move with the appointment — counted once, in the cohort they finally land in.
- Measure a closed window. A month still running will flatter you, because future appointments can’t yet fail to attend.
- Segment by offer and by source. A 42% blended figure hides a 0% row. That is the entire lesson of the table above.
| Metric | Numerator ÷ denominator | What it tells you |
|---|---|---|
| Booking rate | Consults booked ÷ leads captured | Whether your follow-up reaches people |
| Show rate | Consults attended ÷ consults booked | Whether your confirmation and commitment hold |
| Close rate | Patients treated ÷ consults attended | Whether the consult converts |
These three multiply. A clinic with a strong booking rate and a weak show rate looks busy in the CRM and empty in the treatment room, and its owner is usually told to buy more leads — the most expensive possible response.
What does a 42% show rate do to your acquisition cost?
It roughly doubles it. Our blended cost per booking is $162. At 42%, that $162 booking is really a $384 patient, and against revenue per client of $498 you are $79 apart before cost of goods.
Every point of show rate you recover comes straight off your acquisition cost, without touching a single ad. That is why show rate is the highest-leverage number in the chain and the one least likely to be on your report. The full set is in med spa marketing benchmarks.
The default state decides your show rate
Most practice software ships a reminder that reads: “To confirm your appointment, reply C. To cancel, reply X.”
Read what that message does. It makes her decide again — she already decided — and it presents leaving as a fifty-fifty option, in writing, from you.
Use this instead: “Your appointment is confirmed, we’re excited to see you.” Same reminder, same cost, opposite default. “Do you want to confirm?” makes silence mean cancelled. “You’re confirmed” makes silence mean on.
Cadence: two days out, the day before, the morning of. Use her name and the time. A name and a time reads like a person expecting her. A reference number reads like a dentist.
The forty-two appointments an automation cancelled
Forty-two appointments, cancelled by a workflow nobody remembered switching on. It nagged booked patients for a pre-consult form — 188 messages — then cancelled anyone who hadn’t filed one. It caused 79% of all cancellations on that account. Of the forty-two, ten ever came back.
No automation may ever cancel a booked patient. That is not a guideline. If one fires, treat it as an emergency.
The general form of the failure is worth recognising, because it wears different costumes: anything that demands homework before the appointment is protected. Portal logins, photo uploads, intake forms with a deadline. Collect what you need at the visit, or after the deposit clears — never as a condition of keeping a slot she already committed to.
Should a med spa take a deposit?
There is no universally right answer, and anyone who gives you one is selling their favourite tool. Friction is a dial. Between “she wants this” and “she’s in the chair” you choose how much you ask of her, and every step up raises show rate and lowers volume.
| Volume | No-show risk | Use when | |
|---|---|---|---|
| No deposit | Highest | Highest | Filling a new provider’s empty diary; testing a channel |
| Card on file | Slightly lower | Meaningfully lower | Default for most practices, most offers |
| Paid deposit | Lower again | Lowest | High-demand slots; expensive provider time you’re already paying for |
Two things do generalise. Credit it toward the treatment — a fee that vanishes reads as a penalty, a fee that comes off the bill reads as a booking. And disclose it after she’s chosen a time, not in the ad and not in the opener.
Judge the test on attended consults per hundred leads, never on booking count. A deposit will always reduce booking count. That is what it is for.
A no-show is not a lost patient yet
She was interested enough to book, which puts her ahead of every lead in your database.
Contact her within 72 hours, while the intent is still warm, and lead with the slot rather than the failure: “Sorry we missed you Thursday — I’ve got Tuesday at 3 or Wednesday at 11.” No guilt, no lecture. The clinics that treat a no-show as an insult recover almost none of them.
What to actually do this week
- Make your calendar record showed and no-show. Nothing else here works without it.
- Inventory every auto-cancel and auto-release rule in your stack and approve each one deliberately, or switch it off.
- Go and read your actual reminder — the one your software sends, not the one you think it sends. Which way does it point?
- Choose your friction level on purpose, per offer, and write down why.
- Build a 72-hour no-show recovery touch that leads with two slots.
- Report cost per shown, not cost per lead or cost per booking.
None of that is clever. All of it is unglamorous operational work, which is exactly why it is still available to you. If leads aren’t reaching the calendar in the first place, the problem is upstream — start with why med spa leads don’t book instead.