Clients' outcome expectations have been found to play an important role in psychotherapy. Although expectations likely exist before the start of treatment, little is known about how early expectations are developed and the role they play in initial appointment attendance. Adult clients (n = 57) from two psychology department training clinics completed measures of outcome expectations, generalized hope, and distress at the time of referral (after the initial phone conversation). As a set, these variables, along with previous therapy experience and length of wait until the initial appointment, successfully predicted appointment status for 88.7% of the sample. Attendance was more likely when the duration of wait was shorter (OR = 1.58, p < .01) and for those with previous therapy experience (OR = 9.89, p < .05). Initial outcome expectations were significantly correlated with general levels of hope (r = .59, p < .01) and negatively correlated with severity of distress (r = −.48, p < .01). Based on these results, clinical recommendations for increasing the likelihood of attendance and for enhancing expectations are made.