No-show fees in Swiss therapy practices: 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 prerequisites are always a transparent agreement in advance (GTC 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 peculiarities, 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 when booked by telephone. The Code of Obligations (CO) allows two ways to receive money in the event of a breach of contract:

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

Option 2 – Contractual penalty under 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 damage. Prerequisite: The policy must have been explicitly agreed upon and accepted during booking or intake. This is the standard method for all therapy practices.

2. Proportionate Fee Amount: What Applies to Which Industry

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-utilised practices that can often fill vacancies, charging the full session price would be difficult to justify.

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

A legally compliant no-show policy contains three elements: the cancellation deadline (what is the latest time to cancel), the fee amount (fixed lump sum or percentage), and the exception policy (family emergency, sudden illness). Optional but recommended: a goodwill rule for the first missed session.

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

Important: The policy must be communicated and accepted prior to the provision of services. This can take place via GTC consent during online booking, in the intake declaration during 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 specifies clear conditions: The fee must have been communicated at the time of booking, must not exceed the actual damage, and goodwill in the event of cancellations through no fault of one's own is explicitly recommended.

In practice, a two-stage response is recommended: First no-show – friendly enquiry whether everything is okay, no fee charged. From the second no-show onwards – fee is charged, with clearly communicated justification. 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 charge the agreed fee with a few clicks in the Payrexx Dashboard – no reminder procedures, no debt collection proceedings required. Note: A reservation is only valid for a few days – for bookings well 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 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 show up, 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. If cancelled up to 24 hours in advance, you are refunded immediately. In the event of short-notice cancellation or no-show, the cancellation fee applies.'

7. Industry-Specific Peculiarities

Psychotherapy

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

Children (OT, Speech, Paediatric Physio)

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

Practices Covered by KVG (Health Insurance Act)

No-show fees for services covered by basic health insurance are possible, but the fee cannot be billed through the health insurance. Consultation with the professional association (Physioswiss, Occupational Therapy Switzerland, Speech Therapy Switzerland) recommended.

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

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

• Integrate policy into GTC 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

• Customise booking confirmation: always mention no-show policy explicitly

• Record goodwill policy internally: when the fee will be waived

• Monitor initial implementation: how do patients react? Adjust policy if necessary

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

Payrexx supports pre-authorisation for Visa, Mastercard and Mobile Wallets across all plans including Free – no subscription needed for the basic function. In the event of a no-show, you charge 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.