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Cancellation and no-show acknowledgement

Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.

Appointment businesses that charge when someone cancels late or does not attend.

The person reads your notice period and your fee, then signs. You fill in the hours and the amount. It is an acknowledgement, not a waiver of injury.

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Cancellation and no-show acknowledgement

Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.

Fields

  • Notice period

    How many hours before the appointment they must tell you.

  • Late fee

    The amount you charge, in Australian dollars, if they miss that notice.

  • No-show fee

    A separate amount if they do not attend and do not call.

  • Acknowledgement

    A tick and a signature.

Questions

Is this a liability waiver?

No. It only covers a late cancellation or a missed appointment. It does not limit liability for injury.

Can the fee be zero?

Yes. Put zero in the amount if you want the policy on file without a charge.

About these templates

These templates are examples only, to help you get started. They are general information, not legal, medical, clinical or professional advice, and they may not suit your business, your profession or your state or territory.

Before you use any template, you must review and adapt it, and have it checked where needed, so it fits your services, your professional body's rules, privacy and health records laws, and the law where you operate. This matters most for consent, waiver, privacy and minors' forms. You are responsible for the forms you use and the information you collect.

To the extent the law allows, Nopen gives no warranty that the templates are complete, current or fit for any purpose, and is not liable for loss arising from their use. Nothing here excludes, restricts or modifies any right or remedy you have under the Australian Consumer Law that cannot lawfully be excluded.

The templates are not endorsed by or connected with any government agency, including Services Australia, Medicare or the NDIA. Do not add government logos, the Commonwealth Coat of Arms or other official marks to them. Fields that refer to government numbers (such as a Medicare card number) are labels only.

Templates were last reviewed on 14 October 2026. Laws change, so check that a template is current before you rely on it.

Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.

Drafted 14 October 2026.