Text messaging for medical practices: TCPA consent and what to send

Medical practices can text patients, but the rules depend on what the message is. Appointment reminders and other informational texts need the patient’s consent to be contacted at that number, while marketing texts need prior express written consent under the Telephone Consumer Protection Act (TCPA). Every text should identify your practice, make opting out easy and leave out health details.

What is the difference between an informational text and a marketing text?

Informational texts are about care the patient already has with you: appointment reminders and confirmations, pre-visit instructions, a note that results are ready. Marketing texts encourage the patient to buy or use a service: a promotion, a new treatment, a seasonal campaign, an invitation to come back after a long absence.

The difference decides which consent you need. If a reminder also promotes a service, treat the whole message as marketing.

What consent does the TCPA require?

Informational texts: the patient’s prior express consent. Guidelines from CTIA, the wireless industry association, say a person consents to informational texts when they give their mobile number for that purpose, such as appointment reminders. State on your intake form that the number will be used for texts.
Marketing texts: prior express written consent. Under FCC rules, that is a signed agreement (an electronic signature counts) that clearly authorizes your practice to send marketing messages to a specific number, discloses that they may be sent automatically, and states that agreeing is not a condition of purchase.

FCC rules also include a narrow exemption for certain healthcare messages that are free to the patient, such as appointment reminders and lab result notices. The limits are strict: only to the number the patient provided, 160 characters or less, no more than one per day and three per week, a STOP opt-out in every message, and no marketing or billing content. Most practices find collecting consent simpler than staying inside those limits.

The stakes are real. The TCPA lets people sue for $500 per violation, or up to $1,500 if the violation was willful or knowing, and each unlawful text can be a separate violation.

One rule you can set aside: the FCC’s “one-to-one consent” rule, which would have limited each consent to a single seller, was vacated by the U.S. Court of Appeals for the Eleventh Circuit on January 24, 2025, before it took effect, and the FCC later removed it. That doesn’t make shared lead lists safe. CTIA’s guidelines say senders shouldn’t use opt-in lists that were rented, sold or shared.

How do opt-outs work now?

Since April 11, 2025, FCC rules spell out that a person can revoke consent by any reasonable means. Replies such as “stop,” “quit,” “end,” “revoke,” “opt out,” “cancel” or “unsubscribe” count, and you must honor the request within a reasonable time, no more than 10 business days.

A stricter “revoke all” provision, under which opting out of one type of message would stop all of them, was postponed twice: to April 11, 2026, and then to January 31, 2027. In late September 2026 the FCC replaced it with a narrower rule, published on October 26, 2026 and effective November 25, 2026. Under it, an opt-out from informational texts can be treated as applying only to that category, such as reminders, while an opt-out from marketing stops all marketing texts from your practice. You may also designate an exclusive opt-out method, such as replying STOP, if you disclose it clearly.

In practice: process opt-outs right away, sync them across every system that sends texts, and send one final confirmation, as CTIA’s guidelines recommend. Answer HELP with your practice name and phone number. If you text in Spanish, treat replies such as “baja” or “alto” as opt-outs too.

What hours and state laws apply?

Federal rules bar telephone solicitations before 8 a.m. or after 9 p.m. in the recipient’s local time. Some states go further. Florida and Oklahoma, for example, have their own telemarketing laws that require prior express written consent for automated sales texts and limit solicitations to 8 a.m. to 8 p.m. and to three per 24 hours on the same subject. Other states have passed similar laws, so check the rules where your patients live, not only where your office is.

A conservative window, such as 9 a.m. to 8 p.m. in the patient’s time zone, keeps marketing texts inside both the federal and these state limits.

Do you need to register your texting number?

Yes, if you text from a regular 10-digit number. The Campaign Registry, which runs registration for the industry, describes 10DLC (10-digit long code) as the sanctioned standard for business text messaging and says any business that wants to use it must register. Your texting provider registers your brand (the name patients see as the sender) and each campaign (the use case, such as appointment reminders or promotions). Describe each use case accurately.

If the platform stores or sends patient information for you, it is likely a HIPAA business associate, and you need a business associate agreement with it.

What can an appointment reminder say?

HHS allows practices to leave appointment reminders, for example on an answering machine, but advises limiting the information they contain, and HIPAA’s minimum necessary standard points the same way. A safe reminder includes the practice name, the date and time, a way to confirm or reschedule, and the opt-out instruction. It leaves out the diagnosis, the procedure, test results and anything else about the patient’s health. For example:

Reminder from [Practice name]: you have an appointment Tue, Mar 3 at 10:30 a.m. Reply C to confirm or call (555) 555-0100 to reschedule. Reply STOP to opt out.

HIPAA also lets patients ask to receive communications by other means. Record those preferences where your texting system can see them. The same consent-first approach applies to email; see our guide to email marketing for medical practices.

This article is general information, not legal advice. TCPA and state texting rules change often and depend on the facts, so review your texting program with your attorney or compliance advisor.

Related service: Medical marketing

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