Business texting rules for medical practices

Appointment reminders are the easy part of texting patients. The harder questions start when a practice wants to text a seasonal offer, a new service, a reactivation message to patients who have not booked in a year, or a request for a review. Those messages sit under different rules: wireless industry guidelines that decide whether the texts get delivered at all, the FCC’s consent rules for marketing, a revocation rule that changes on November 25, 2026, state telemarketing laws, and HIPAA’s marketing rules.

This guide covers marketing and other non-reminder texts. For reminders under the FCC healthcare exemption, including its frequency and length limits, see our guide to text message appointment reminders. For phone calls, see marketing calls, Do Not Call and the TSR and call recording consent, and for email, see healthcare email marketing. Registering your sending number with the wireless providers is covered step by step in our guide to 10DLC, toll-free and short code registration. How opt-outs and patient data flow through a CRM that sends texts is covered in our guide to CRM and marketing automation for practices. Patients who ask to use WhatsApp or another messaging app raise different questions, covered in our guide to WhatsApp and messaging apps for medical practices. For notifications sent through a website or web app instead of text, see our guide to web push notifications for practices. For one opt-out list across texts, email and calls, see patient opt-outs for email, text and calls.

This is general information, not legal advice. Sources cited were checked on October 30, 2026: 47 CFR 64.1200 (eCFR, current text), the FCC order published in the Federal Register on October 26, 2026 (91 FR 67214, effective November 25, 2026), CTIA’s Messaging Principles and Best Practices (May 2023), Florida Statutes 501.059 and 501.616, Maryland Commercial Law 14-4501 to 14-4503, and 45 CFR 164.501 and 164.508. Rules differ by state, and whether a given text is telemarketing or a health care message is a question for counsel. Have a health care attorney review your texting program before it launches.

Three kinds of text, three levels of consent

Wireless industry guidelines and the FCC rules both sort texts by what they do. CTIA’s Messaging Principles and Best Practices (May 2023), the voluntary guidelines written by the wireless industry’s trade association, describe three categories:

Conversational: the patient texts first and the practice replies with relevant information. The guidelines say no further permission is expected.
Informational: the patient gives a number and asks to be contacted, for example for appointment reminders or alerts. The guidelines expect the patient to agree to texts for that specific purpose when they give the number.
Promotional: a message with a sales or marketing promotion. The guidelines expect written consent before the first promotional text, and note that adding a call to action, such as a coupon code, to an informational text may move it into this category.

The practical point is the last one. A reminder that ends with “Book your [service] this month and save” is no longer a plain reminder. Keep reminders and promotions in separate messages, sent under separate consents.

Carrier registration: why marketing texts get blocked

Texts a business sends through a texting platform travel over the wireless providers’ networks, and those providers set their own terms for business traffic. The CTIA guidelines say individual service providers may add consumer protection measures for business senders, including campaign preapproval, vetting, in-market audits and filtering of unwanted messages. They also say an authentication and validation process should be used to verify a sender’s authority to text-enable a phone number.

In practice, this is the registration step a texting platform asks for before a practice can send business texts from a standard 10-digit number: the practice’s legal name and details, and a description of each kind of message it will send, with sample messages and how patients opt in. These steps are set by contracts between providers and platforms, not by statute, and they change. Your platform’s current requirements are the ones that apply.

Use: register the practice under its legal business name, describe reminders and marketing as separate uses, and submit sample texts that match what you will send. Avoid: registering for reminders and then sending promotions from the same number, or spreading messages across several numbers to avoid limits. The CTIA guidelines name that second practice, snowshoe messaging, as one senders should not engage in.

What the CTIA guidelines expect from a business sender

A clear call to action at sign-up that tells the patient what the program is, the number the texts come from, who is sending them, any fees, and how to opt out, with a link to the privacy policy.
A confirmation text for recurring programs that names the program, gives a way to get help, explains how to opt out and states the message frequency.
A record of each opt-in: the time, the method (a form, a keyword, a signed paper form), the wording the patient saw, the program, and the number.
No rented, bought or shared opt-in lists. An opt-in applies only to the sender and program it was given for.
Links that clearly identify the website owner, and a link shortener dedicated to the sender rather than a shared public one.
A privacy policy that is easy to find and describes how the sender collects, uses and shares information.

The FCC rule for marketing texts: prior express written consent

The FCC’s rules at 47 CFR 64.1200 treat a text as a call. Section 64.1200(a)(2) says a call that includes or introduces an advertisement or constitutes telemarketing, made with an automatic telephone dialing system or an artificial or prerecorded voice to a wireless number, needs the called party’s prior express written consent. The same paragraph excludes a call that delivers a “health care” message made by or on behalf of a HIPAA covered entity or its business associate.

The rule does not define a health care message. A text that sells a cosmetic treatment, a membership or a product is a poor fit for that phrase, and a practice should get counsel’s view before relying on the exclusion for anything promotional. Whether a given texting platform counts as an automatic telephone dialing system is also a legal question. The safer design is to collect prior express written consent for each marketing text program.

Section 64.1200(f)(9) defines prior express written consent as a written agreement, signed by the person, that clearly authorizes the seller to send advertisements or telemarketing messages using an automatic telephone dialing system or an artificial or prerecorded voice, and that names the phone number. It must include a clear and conspicuous disclosure that:

by signing, the person authorizes the seller to send them telemarketing calls using an automatic telephone dialing system or an artificial or prerecorded voice; and
the person is not required to sign, or agree, as a condition of buying any property, goods or services.

An electronic signature counts where federal law or state contract law recognizes it. For a practice, that means a separate, unticked box on the intake form or website, never bundled into consent to treat or the reminder consent. Use: “I agree to receive marketing texts from [Practice name] at [number], sent with automated technology. Consent is not a condition of any purchase or of care. Message frequency varies. Reply STOP to opt out, HELP for help. Message and data rates may apply.” Avoid: a single box that covers reminders, billing and promotions.

Opt-outs now, and what changes on November 25, 2026

Under the current text of 64.1200(a)(10), a patient can revoke consent by any reasonable method. A reply of “stop”, “quit”, “end”, “revoke”, “opt out”, “cancel” or “unsubscribe” is a reasonable method by definition, other wording counts if a reasonable person would understand it as a request to stop, and a sender may not designate an exclusive way to opt out. Requests must be honored within a reasonable time, not more than ten business days. Under 64.1200(a)(12), one confirmation text is allowed if it only confirms the request and contains no marketing.

An FCC order published in the Federal Register on October 26, 2026 (91 FR 67214) amends these paragraphs, effective November 25, 2026. Under the amended text:

A sender may designate one or more of these as the exclusive way to opt out: an automated voice or keypress opt-out on a call, a reply text using one of the standard words above, or a website or phone number set up for opt-outs. The method has to be disclosed clearly and conspicuously in the call or text.
A sender that designates reply texts as the exclusive method can meet the disclosure duty by including at least one of the standard words in each text, as long as it treats any of the standard words as a valid opt-out.
An opt-out sent in reply to an informational text may be treated as applying only to that category of informational texts.
An opt-out sent in reply to a marketing text revokes consent to all future marketing calls and texts from that sender.
A sender that does not designate an exclusive method must still process opt-outs made by any reasonable means. Each opt-out must be honored within ten business days.

The same day, the FCC published a proposal seeking comment on shortening the time to honor opt-outs and on other changes, so this area may move again. For a practice, the simplest rule holds under both versions: when a patient replies STOP to a marketing text, stop all marketing texts at once, send one plain confirmation if you send any, and record it where the front desk can see it.

Do-not-call lists and quiet hours

Section 64.1200(c) bars telephone solicitations to a residential subscriber before 8 a.m. or after 9 p.m. local time at the called party’s location, and to a number on the national do-not-call registry. Section 64.1200(e) applies these rules to telephone solicitations and telemarketing texts to wireless numbers. The definition of telephone solicitation in 64.1200(f)(15) excludes a message to a person with that person’s prior express invitation or permission, or to a person with whom the caller has an established business relationship.

Under 64.1200(f)(5), an established business relationship for this purpose is based on a purchase or transaction in the 18 months before the call, or an inquiry or application in the three months before it, and a person’s request not to be called ends it. Section 64.1200(d) also requires a written policy and an internal do-not-call list for telemarketing, with requests honored within ten business days. None of this replaces the prior express written consent needed for automated marketing texts under 64.1200(a)(2).

State laws with stricter limits

State telemarketing laws can be stricter than the federal rule. Two we read in full, both of which reach texts:

Florida: Statutes 501.059 defines a telephonic sales call to include a text message, requires prior express written consent for unsolicited telephonic sales calls made with an automated system for selecting and dialing numbers, and defines signature to include checking a box or replying yes to a text. Before suing over text solicitations, a person must first reply STOP, and the sender has 15 days to stop. Separately, Statutes 501.616(6) bars commercial telephone sellers from soliciting before 8 a.m. or after 8 p.m. in the called person’s time zone, or more than three times in 24 hours on the same subject. Whether a practice is a commercial telephone seller under that part of Florida law is a question for counsel.
Maryland: Commercial Law 14-4502 requires prior express written consent for telephone solicitations that use an automated system for selecting or dialing numbers, and bars telephone solicitations between 8 p.m. and 8 a.m. in the called party’s time zone or more than three times in 24 hours on the same subject. The definition of prior express written consent in 14-4501 names text messages. Under 14-4503, a person harmed can sue for up to 500 dollars or actual damages, more for willful violations.

Other states have similar laws and bills, and they change from session to session. A workable design standard for a practice: send marketing texts only between 8 a.m. and 8 p.m. in the patient’s time zone, no more than one a day, with prior express written consent on file. Then check each state where you have patients with counsel.

HIPAA: when a text is marketing

HIPAA has its own definition of marketing, separate from the FCC’s. Under 45 CFR 164.501, marketing is a communication about a product or service that encourages the recipient to buy or use it. The definition excludes communications for treatment and certain operations purposes, including describing a health-related product or service the covered entity itself provides, unless the practice receives financial remuneration from a third party for making the communication. Under 164.508(a)(3), using protected health information for marketing needs the patient’s written authorization, with narrow exceptions for face-to-face communications and promotional gifts of nominal value.

Two consequences for texts. A text about a third party’s product, paid for by that third party, needs HIPAA authorization as well as TCPA consent. And a list built from patient records, such as “patients seen for [condition]”, is protected health information, so the targeting itself is a HIPAA question. Our HIPAA marketing rules guide covers the definitions in more depth.

Keep health details out of marketing texts. A text can be read on a lock screen or by someone else with the phone. Use: “[Practice name]: our new evening hours start [date]. Reply STOP to opt out.” Avoid: “Time for your next [condition] treatment.”

Review requests, reactivation and other gray areas

Review requests: a text asking a patient to review the practice does not sell a service, but it is not a reminder either, and it falls outside the FCC healthcare exemption’s listed purposes. Send it under the patient’s texting consent, keep it free of offers, and never tie it to a discount. Our review replies guide covers what to do when reviews come in.
Reactivation: “We miss you, book now” encourages a purchase, so treat it as marketing and send it only with prior express written consent. A recall message for care the clinician has recommended is closer to treatment, but keep it free of offers. See our patient recall guide.
Giveaways and contests: a text that enters patients in a drawing is marketing, and contest rules apply as well. See our giveaway rules guide.
Leads from forms: a person who filled out a website form asked to be contacted about that inquiry. That is not consent to a marketing sequence unless the form said so in the terms above. See our guide to website contact forms.
Bought or shared lists: never. The CTIA guidelines say senders should not use rented, sold or shared opt-in lists, and an opt-in given to another business is not consent to hear from you. See our guide to buying patient leads.

Notes by specialty

Dental: recall texts and whitening or aligner promotions are different programs. Keep hygiene recall under treatment wording, and send promotions only to patients who signed the marketing consent.
Med spa: promotions are the core use, so the marketing consent, the quiet hours and the STOP handling carry the weight here. Do not name the treatment a patient had in a text that may be read by others. See our gift card and promotion rules.
Chiropractic: new patient offers sent by text are marketing, and any offer terms must match the advertised price. See our guide to chiropractic new patient offers.
Integrative and behavioral health: the fact that a person is a patient can itself be sensitive. Keep marketing texts generic, and keep any list built from clinical records out of marketing unless counsel has signed off.

Illustration: splitting one texting program into two

This illustration is invented to show the method. It does not describe a real practice or result.

[Practice name] sends reminders and monthly specials from the same number, under a single intake box that says “I agree to receive texts.” A patient replies STOP to a special and keeps getting reminders, then complains that they asked for the texts to end.

After review, the intake form has two boxes: one for appointment texts at the number the patient gives, and one unticked box with the marketing consent wording above. The texting platform registration lists reminders and marketing as separate uses with their own sample messages. Marketing texts go out only between 8 a.m. and 8 p.m. in the patient’s time zone, each one says “Reply STOP to opt out”, and a STOP to a marketing text ends all marketing texts while reminders continue under the reminder consent. The front desk can see each patient’s texting status in the scheduling system.

Checklist before you send a marketing text

Separate reminder consent from marketing consent on intake forms and web forms.
Use marketing consent wording that names the number, says automated technology is used, and says consent is not a condition of care or purchase.
Record the time, method, wording, program and number for each opt-in.
Register with your texting platform under your legal name, with reminders and marketing described as separate uses.
Include the practice name and a STOP instruction in each marketing text.
Stop all marketing texts at once when a patient replies STOP to one, and log it.
Send marketing texts only between 8 a.m. and 8 p.m. in the patient’s time zone, and check the state laws where your patients live.
Keep diagnoses, treatments and other health details out of marketing texts.
Never use bought, rented or shared lists.
Recheck your opt-out process against the FCC rule that takes effect on November 25, 2026.

How we help

We build websites, local search, Google Ads and lead generation and AI front desk tools for independent practices and health businesses. For texting, that means intake and web forms that collect reminder and marketing consent separately, consent records your team can find, and message templates that keep health details out, with each template listed for your attorney to review. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules hub.

Do we need written consent to send marketing texts to patients?

Under 47 CFR 64.1200(a)(2), texts that include an advertisement or constitute telemarketing, sent with an automatic telephone dialing system, need prior express written consent. The rule excludes health care messages from HIPAA covered entities, but promotional texts are a poor fit for that exclusion, so get counsel’s view before relying on it.

Is an existing patient relationship enough to send promotions by text?

An established business relationship exempts a message from the federal do-not-call rules under 64.1200(f)(15), but it does not replace prior express written consent for automated marketing texts under 64.1200(a)(2).

What is carrier registration for business texting?

Wireless providers set their own terms for business texts. CTIA’s Messaging Principles and Best Practices (May 2023) say providers may require campaign preapproval, vetting and audits. Your texting platform will ask for your business details and a description of each kind of message before you can send.

What changes for opt-outs on November 25, 2026?

Under the FCC order at 91 FR 67214, senders may designate an exclusive opt-out method if they disclose it, and a STOP reply to a marketing text revokes consent to all marketing texts from that sender. Opt-outs must still be honored within ten business days.

What hours can we send marketing texts?

The federal rule at 64.1200(c)(1) bars telephone solicitations before 8 a.m. or after 9 p.m. local time. Maryland Commercial Law 14-4502 bars them between 8 p.m. and 8 a.m., and Florida Statutes 501.616 sets the same window for commercial telephone sellers. An 8 a.m. to 8 p.m. window meets all three.

Can a marketing text mention a patient’s treatment?

Avoid it. Using protected health information for marketing can need written authorization under 45 CFR 164.508(a)(3), and a text can be read by others. Keep marketing texts free of health details.

Marketing texts from your practice: registration, consent and opt-outs