Cancellation and No-Show Policy Acknowledgment (Sign Before the First Visit)
A one-page form the customer signs before the first visit: the notice window, the late-cancellation fee, the no-show or lockout fee, how skipped visits work on a recurring plan, and how the fee is paid.
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What’s in this template
Cancellation and No-Show Policy Acknowledgment
Signed before the first visit. It records the cancellation terms the customer was shown and agreed to.
1. Parties and Service
- Company: Company Name
- Customer: Customer
- Service address: Service Address
- Service: Service
- Policy starts: Policy Starts
2. Notice
- Cancel or reschedule at no charge with at least Notice Required (hours) hours' notice.
- Larger jobs: Notice for Large Jobs
3. Fees
- Late cancellation (inside the notice window): Late-Cancellation Fee
- No-show or lockout (we arrive and cannot get in or reach anyone): No-Show or Lockout Fee
- Minutes we try to reach the customer before a no-show applies: Minutes We Try to Reach You
4. Recurring Plans and Payment
- Recurring plans: Recurring Plan Terms
- How a fee is paid: How the Fee Is Paid
5. Sign-Off
The customer confirms they read the notice window and fees above before the first visit, agree to them, and received a copy.
Company representative signature line
Customer (received a copy) signature line
Cancellation policy acknowledgment questions, answered
What is a cancellation policy acknowledgment?
A short form the customer signs to show they read your cancellation terms before the first visit. It states how much notice you need, what you charge for a late cancellation and for a no-show, and how the fee is paid. It turns the policy from a line in a text thread into something the customer agreed to in writing.
When should the customer sign it?
Before the first visit, at the same time they accept the quote or booking. For existing recurring customers who never saw a policy, send the new terms with a start date a couple of weeks out and have them sign or reply to accept.
What notice window should I put on the form?
Whatever you can actually hold to. The window should give you enough time to fill the slot or absorb the gap, and it should be the same number you say on the phone and print on the quote. The form has a field for it, plus a separate field for bigger jobs that are harder to refill.
What is the difference between a late cancellation and a no-show?
A late cancellation is when the customer tells you, but inside the notice window. A no-show or lockout is when you arrive and cannot get in or reach anyone. Most providers charge less for the first and the full visit price for the second, and this form has a separate line for each.
Does this form satisfy my state's rules on cancellation fees?
No form can promise that. Rules on what a service provider may charge, and on charging a saved card, vary by state and by the terms of your payment processor. Use this as a record of what the customer agreed to, and check with your state agency or a local attorney for what applies to you.
Do I need an account to use this form?
No. Download the blank form and print it, or fill in the terms online and download a PDF. Neither needs an account.
Related
Get the policy accepted before the first visit
In EosLog the customer accepts your terms on the quote on their phone, and the accepted policy stays attached to the job so a late-cancel or no-show fee matches what was agreed.