Missing an appointment would be a huge deal to me. In the 19 years I have been with my therapist she has maybe last minute cancelled our appointment 5 times due to illness, or a family emergency. I think I cancelelled a couple of times due to the weather. I have a standing apointmenmt which has never changed. I kid her that she is a time share and I have her on Saturday mornings at 8:00am. No one else get that time!! She suprised me this week because she always takes the Saturday after Thanksgiving off but this year she is working! She did change my appointment time to 9:00 and that's cool by me. She is very thoughtful and always let's me know when her planned vacation time off days are so I know well in advance if we are not meeting. She always lets me know if I need her I can always call her cell phone and leave a message if she does not answer. She always calls back within that day unless she is out of the country then she can't.