Heather, part of the front desk team at Lakeline Vision Source, discusses the schedule with our intern, Courtney Ta. Photo courtesy of Dr. Sorrenson.
After you know when pre-appointing makes sense, what are the strategies to do it well?
By Laurie Sorrenson, OD, FAAO
Feb. 26, 2026
My previous column discussed when it makes sense to pre-appoint. This time, I’m addressing tips on how to incorporate pre-appointing. Remember, I do NOT believe every office should be pre-appointing!
I spend a lot of time on calls with cold starts, new practices and new associates. For them, pre-appointing is critical for growth.
You have decided you want to pre-appoint. Now what?
The Most Important Part: Tell the Patient the “Why”
Simply saying, “We recommend yearly exams…” is not enough.
Patients are more likely to return if you give them a reason to return.
Mick Kling, OD, says, “Almost every patient has something that can be justifiably monitored annually—you just have to tie it to why they should return.”
Imagine your PCP measures your blood pressure and says: “Your blood pressure was on the high end of normal today. I’m not overly concerned, but I want to see you next year to make sure you’re not developing hypertension.”
You would likely return. Right?
Now compare that to: “Everything looks great. We recommend yearly physicals, so we’ll see you next year.”
It’s a very different emotional impact.
In optometry, we have so many legitimate reasons:
- Mild dry eye
- Borderline IOP
- Small optic nerve
- Optic cupping asymmetry
- Early lens changes
- Family history of glaucoma
- Mild lattice
- Myopia progression risk
- Contact lens overwear history
- Diabetes
HOW TO COMMUNICATE YOUR WHY
Almost every patient chart contains a clinically defensible reason to return—you just have to look for it and articulate it clearly.
One framework that has shaped how I close every exam is guidance from Gary Gerber, OD, on his “Four Rs.” I’ve taught this to associates, interns and students at UHCO for more than 20 years. It changed the way I communicate with patients, and I truly believe it made me a better doctor.
The Four Rs give structure to the end of the visit so patients leave understanding exactly what happened, what it means and when they should come back.
1. Repeat the Chief Complaint
Start by circling back to why they came in.
“Today you came in for your annual exam.”
“You mentioned your eyes have been burning.”
“You told me your near vision hasn’t been as clear.”
This shows you were listening.
2. Refer to the Exam Findings
Next, connect their concern to what you found.
“The inside and outside of your eyes look healthy, but I did find a small change in your distance prescription.”
“I found signs of Meibomian Gland Dysfunction, which explains the burning you’re experiencing.”
Now the visit has context.
3. Recommend Solutions
Then clearly state what you recommend: “I recommend we update your glasses prescription.”
Or, “I recommend we start lid hygiene, drops, and omega-3 supplements for the MGD.”
Patients don’t want ambiguity—they want guidance.
4. RTC (Return to Clinic)
Finally, close the loop with a specific follow-up.
“I’d like to see you back in a year to monitor your eye health and prescription.”
“I want to see you back in one month to evaluate how your eyes are responding to treatment.”
Then when you are going to pre-appoint say:
“I’m going to reserve you an appointment. We’ll confirm it ahead of time, okay?”
I think that final “okay?” matters. It creates agreement, not assumption.
I believe it is more efficient and effective for the doctor or the scribe to make that pre-appointment in the exam room. I don’t have any data to back that up but since you are already discussing when and why to come back, why not take the 30 seconds to make the appointment?
The rest of the system matters
One reason some doctors resist pre-appointing is that they don’t have a strong communication/reminder/confirmation system in place.
“Pre-appointing only works if your recall and confirmation systems are airtight,” says Dr. Kling.
You need to think through the following before implementing pre-appointing:
When do you send reminders? And how many? 1 month? 1 week? 3 days? 2 days? The day before? 2 hours before? 1 hour before? (I have experimented with different timing and tracked no show rates. Below, I’ll share what we do.)
How many recalls?
Through what medium? What’s most effective: text, email or phone calls?
What happens if someone doesn’t confirm? Do you move them to a separate schedule?
At what point do you remove them from the schedule?
If you don’t have answers, you don’t have a system.
Lakeline Vision Source’s Confirmation Protocol
Here’s our current protocol at Lakeline Vision Source that we arrived on after experimentation:
30 days prior:
We have an automated text and email informing patients of their appointment date/time and asks them to confirm and complete online history and demographic forms.
Our strategy is a little different. We don’t consider someone confirmed unless they have updated their history, demographic and HIPAA forms online. In our experience, almost every one of our no shows have not filled out their forms ahead of time. (Here’s what I recommend for no shows.)
7 days and 3 days prior:
We send email and text with reminders and our information about our Optos imaging fee.
1 day and 1 hour (not 2 hours!) prior: We send another text one day ahead and also one hour ahead.
If a patient hasn’t responded and hasn’t filled out their forms, we move them to a side schedule. Before we do that, we text the patient that since they haven’t responded we are assuming they want to cancel their appointment. Many people will respond at that point!
Two Practical Tips
Special Population Adjustments
David A. Wagner, OD, says that for patients over 65 or Medicaid patients who have not confirmed three days prior, staff calls directly. It represents only about 5% of appointments—but that 5% matters.
We also call patients to take their history if they are over the age of 60 and haven’t done it 24 hours before their appointment.
Use a Different Code for Pre-Appointments
We use a different scheduling code when a patient is pre-appointed at checkout. That way we can tell at a glance that it is a pre appointment. Ours is the billing code 1000. That way anyone can tell by looking at the schedule that it was a pre appointment.
Find Success with Pre-Appointing Strategies
Always remember the why. Patients return when they understand the clinical reason, not just the calendar interval.
Be specific with the way you communicate in the office and with digital communications. Use a good reminder system, don’t be scared to remind frequently and through different channels. Your pre-appointment system matters. Get it right, and your practice will grow.
Read another column by Dr. Sorrenson here.
Read more insights from our editors here.
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Laurie Sorrenson, OD, FAAO, ABO, is president of Lakeline Vision Source in Cedar Park, Texas, CEO of ODs Care working with Half Helen, Director of Practice Management and Austin Administrator of Vision Source and the Professional Editor of Review of Optometric Business (ROB). To contact her: lsorrenson@gmail.com |
