A message that says “See you Tuesday at 10” and a message that says “It has been a while, book a check-up” look alike on a phone. Under the rules, they are not the same thing. The first helps a patient who already has an appointment. The second asks for new business. That difference decides which consent you need, what the message must contain and what happens when someone says stop.
This guide has two jobs. It compares text and email as channels, and it separates reminders from marketing so you can see where the line sits. It is general information, not legal advice, and it does not replace advice from a lawyer or your regulator.
Two kinds of message
Appointment messages serve a patient who has already booked: a confirmation, a reminder, a change of time or place, a note about what to bring or where to park.
Marketing messages promote the clinic: a newsletter, a seasonal offer, a “we have openings” note, a reminder that a patient is due for a visit, a notice of a new service.
Many messages sit in between. A recall note (“you are due for your six-month visit”) is clinical in spirit but promotional in effect, since it invites someone to book. Laws in different places treat such messages differently, and the label you give a message is not the test. What matters is its purpose and content, so it is safest to treat borderline messages as marketing until an adviser says otherwise. Our recall and reactivation message templates are written with this in mind.
A message that mixes both is a trap. A reminder with a promotion attached may be treated as marketing in full.
The rules, in general terms
Rules differ by country, and in the United States by state as well. We name the main ones so you know what to look up.
Canada: CASL. Canada’s anti-spam law, enforced mainly by the CRTC (with the Competition Bureau and the Privacy Commissioner also involved), covers commercial electronic messages, which include email and text. In general terms it asks you to have consent before you send, to identify who the message is from and to provide a working way to unsubscribe. The CRTC publishes guidance on express and implied consent, and the details matter, including how long implied consent lasts and how you prove consent. Read the CRTC’s current guidance and get advice for your situation.
United States: CAN-SPAM for email. The Federal Trade Commission’s guide for businesses says commercial email must have accurate sender information, a subject line that matches the content, a clear disclosure that it is an ad, a valid postal address and a clear way to opt out. The FTC also says opt-out requests must be honoured within 10 business days. Messages whose primary purpose is transactional or relationship-based are treated differently, though the FTC reads those categories narrowly, and a mixed message can count as commercial.
United States: TCPA for texts. Texts sent with automated systems fall under the Telephone Consumer Protection Act, which the Federal Communications Commission and other agencies enforce. In general terms, marketing texts call for stricter consent than informational ones, and consent can be withdrawn. State rules may add more. We do not summarise the details here because they have changed in recent years. Check the FCC’s current pages and ask a lawyer.
Patient information also has its own privacy rules, which is another reason to keep messages short and non-clinical.
If you are unsure whether a particular message needs consent, ask before sending, not after.
Text compared with email
| Text | ||
|---|---|---|
| Speed | Arrives on the phone straight away | Waits until the patient checks the inbox |
| Length | Very short | Room for detail, links and attachments |
| Best for | Short-notice reminders, “reply to confirm” | Directions, forms, longer information, newsletters |
| Risk | Feels personal, so mistakes or too many messages irritate | Gets lost in an inbox or filtered as junk |
| Who it reaches | Anyone with a mobile number | Anyone who checks that address |
| Opt-out | A reply such as “STOP” | An unsubscribe link, or a reply |
Neither channel works for every patient. Some people ignore email, and some do not want texts. Let patients choose, record their choice and respect it. If a patient has no mobile number or email on file, your system cannot send them anything, so check at booking.
Your booking software probably decides what you can do. Some systems include text reminders only on certain plans, or charge for text credits, and some are available in only some regions. Check with your provider.
What goes in an appointment reminder
Keep it dull and brief. A reminder needs only:
- Who it is from. The clinic’s name, so the patient recognises it.
- When and where. Date, time and location (and practitioner’s first name, if that is your habit).
- How to confirm, change or cancel. A link, a reply word or a phone number.
- How to stop reminders, if your system sends them by text. “Reply STOP to opt out” is a common form.
An example for a text:
Reminder from [Clinic name]: your appointment is on [day, date] at [time]. Reply C to confirm or call [number] to change. Reply STOP to opt out.
An example for an email subject and opening line:
Subject: Your appointment on [day, date] Hello, this is a reminder of your appointment at [Clinic name] at [time].
These show the shape only. Fill in your own clinic’s details.
What to keep out of messages
Texts and emails can be seen on a lock screen, read by a family member, sent to a wrong number or stored by a third party. So keep clinical details out.
- Do not name the condition, the treatment or the body part. “Your appointment” is enough. “Your sciatica follow-up” is not.
- Do not include results, diagnoses or notes. Send them through your secure patient portal or in person.
- Avoid full names and dates of birth where a first name will do.
- Do not include links that open a form with health information without a login or other protection.
- Do not put anything intimate in a subject line or preview. That text appears before the message is opened.
Ask your booking provider where the messages are sent from, and how it handles patient data.
How often
For appointment messages, fewer is better. A confirmation at booking, one reminder before the visit and a note if something changes is usually enough. A second reminder can be worth it for visits that are easy to forget, but a patient who gets four messages for one appointment will start to ignore all of them.
For marketing messages, set a rhythm you can keep and that patients will tolerate. A monthly newsletter is a common starting point. See how to run a clinic newsletter and patient reactivation. Watch unsubscribes and complaints. If they rise, send less or make your messages more useful.
Do not use appointment reminders as a cover for promotion, and do not send marketing by text to people who gave you their number only for scheduling.
Consent, in practice
A few habits protect you and your patients, whichever country you are in:
- Ask at booking and write it down. Record whether each patient agrees to reminders, and separately whether they agree to marketing. Keep the date and how they agreed.
- Keep the two lists separate. Someone who wants reminders may not want a newsletter.
- Make saying no easy and process it quickly. Do not make anyone log in or give extra information to opt out.
- Do not buy or borrow lists. Consent is given to you, not to a stranger.
- Identify the clinic in every message, with a way to reach you.
- Review any outside provider. If someone sends messages for you, you are still responsible for what is sent.
- Revisit old lists. Consent can expire or be withdrawn, so do not mail a list you collected years ago without checking.
For a plain-language start on email, see do I need consent to email patients under CASL and CAN-SPAM. It is general information and not legal advice.
A short decision guide
- Is it about an appointment the patient already has? Treat it as an appointment message. Keep it short, without clinical detail and easy to stop.
- Does it invite the patient to book, buy or return? Treat it as marketing. Check consent, identify yourself and include a clear opt-out.
- Is it both? Split it into two messages, or treat the whole thing as marketing.
- Is it urgent and short? Text may suit. Is it long or visual? Email may suit.
- Not sure? Ask an adviser before you send.
Where we can help
If your reminders go out but patients still miss visits, or your newsletter goes nowhere, the cause is usually the message or the list rather than the channel. If you want help with email, see our email newsletters service. If you would like a person to look at how your clinic appears and books online before you decide where to invest, claim my audit. We look at your profile, website and booking path as a patient sees them, and we send you what we find. The button reads “Claim my audit”.