Appointment system was introduced to the University of Benin Teaching Hospital at the initial stage of the Hospital development. This is a new experience to the local community which is largely illiterate. The appointment breaking was low contrary to expectation. Indifference or negligence accounted for a high percentage of defaulting. The system was deemed to be good by 66.4 per cent of the defaulters interviewed only 1.2 per cent felt that it was bad. Efforts by the health visiting Sister to visit the defaulters at home and persuade them to attend the clinic reduced the number of broken appointments. The habit of breaking appointments by parents/guardians of children who showed indifference or negligence were more difficult to remedy. For a referral system to be effective in a largely illiterate community where referral system is new, knowledge of the reasons for breaking appointments in the community should be known and remedied. Promotion of personalized attention and intensive health education are essential.