Door hangers, flyers and neighborhood apps: rules for medical practices

A stack of flyers and a weekend of walking the streets around a new office is one of the oldest ways to tell neighbors a practice exists. Door hangers, flyers left at local businesses and posts on neighborhood apps are cheap, local and quick to run. They also touch a federal mailbox law, city handbill codes, advertising law, the federal ban on inducements to Medicare and Medicaid patients and, the moment a patient appears in the piece, HIPAA.

This guide is for practice owners and office managers planning hand-delivered print or posts on a neighborhood app. It covers where a flyer may and may not go, what cities can require, what the flyer may say and offer, and how to post as a business on a neighborhood app. Mailed pieces are covered in our guide to direct mail and printed newsletters, codes on printed pieces in our guide to QR codes on print ads, and opening events in our grand opening guide. For the online side of neighborhood marketing, see our guide to Nextdoor for medical practices. If you plan to mail to a rented address list instead, read buying mailing lists for a medical practice.

The short version

• Never put an unstamped flyer in or on a mailbox. 18 USC 1725 makes it a federal offense to knowingly and willfully deposit unpaid mailable matter in a letter box to avoid postage, and the USPS bars anything without postage placed on, attached to or hung from a mail receptacle.
• Cities can set rules for handbills. Tempe and San Francisco, for example, bar leaving handbills at a home that posts a sign saying the occupants do not want them.
• A flyer is an advertisement. Claims must be true and backed by evidence (15 USC 45 and 52), and offer terms belong on the piece.
• A free exam or gift aimed at people on Medicare or Medicaid can be a prohibited inducement under 42 USC 1320a-7a(a)(5).
• No patient names, photos or stories on a flyer or post without a signed HIPAA authorization (45 CFR 164.508).
• On Nextdoor, promotion has to come from a Business Page, not a personal account, under the platform’s self-promotion policy.

The mailbox is off limits

18 USC 1725 says that whoever knowingly and willfully deposits mailable matter, such as circulars or sale bills, on which no postage has been paid, in a letter box approved or accepted by the Postal Service for mail, with intent to avoid paying postage, shall for each such offense be fined. A door hanger slipped into a curbside mailbox is the textbook case.

The USPS rules go further than the statute. Domestic Mail Manual section 508, part 3.1.3, says mail receptacles may be used only for matter bearing postage, and that no part of a mail receptacle may be used to deliver matter without postage, including items placed on, supported by, attached to, hung from or inserted into it. Matter found that way is subject to the same postage as if it had been mailed. So a flyer tucked under the flag or rubber-banded to the box is also out.

Part 3.1.2 sets two limits on that reach. Door slots and nonlockable bins or troughs used with apartment house mailboxes are not letter boxes under 18 USC 1725, and the post or other support is not part of the receptacle. That does not make the post a good place for a flyer. City handbill and litter codes can still apply, as the next section shows.

The Supreme Court upheld 18 USC 1725 in USPS v. Council of Greenburgh Civic Associations, 453 U.S. 114 (1981), holding that a letter box is not a public forum. The case involved civic groups, not businesses, so a practice has even less room to argue it. If you want a flyer in the mailbox, mail it. Our direct mail guide covers mailing lists, offers and what shows on the envelope.

City handbill rules: two examples

Cities regulate door-to-door distribution in their own codes, and the rules differ from place to place. Two examples show the pattern.

• Tempe, Arizona. Tempe City Code section 3-21, as quoted on the city’s handbills page, bars leaving any commercial or noncommercial handbill on premises if someone there asks you not to, or if a sign near the entrance says “No Trespassing,” “No Peddlers or Agents,” “No Advertisement” or any similar notice. Section 3-22 says that on unposted homes a handbill must be placed so it cannot blow about, and that mailboxes may not be used when postal law prohibits it. The city says violations are punishable by a fine of up to 2,500 dollars or up to six months in jail, or both.
• San Francisco, California. San Francisco Public Works says that once a resident posts a “No Handbills” sign of at least eight square inches in a conspicuous place, it is illegal to distribute handbills anywhere on the property, including the porch, yard, steps, hallway or mailbox. It defines a handbill to include an advertisement for services, and says violations can be fined up to 250 dollars.

The Supreme Court has given towns room to regulate commercial door-to-door activity. In Breard v. City of Alexandria, 341 U.S. 622 (1951), it upheld a city ordinance that barred going door to door to sell without the prior consent of the residents. In Watchtower Bible and Tract Society v. Village of Stratton, 536 U.S. 150 (2002), it struck down a permit rule for door-to-door advocacy, while noting the ordinance might have been tailored to the village’s interests if it had covered only commercial activities and the solicitation of funds. A practice promoting its services is on the commercial side of that line.

No federal rule tells a practice which city codes apply. We recommend looking up the handbill, solicitation, peddler and litter sections of the code for each city or county you plan to cover, checking whether a permit or license is needed, and writing the answer into the brief you give the people distributing.

Where else flyers go

Flyers left at gyms, salons, cafes or offices sit on someone else’s property, and posting on poles, kiosks or windshields falls under local sign and litter codes. No federal rule covers this. We recommend asking the business owner first and checking the city’s sign rules before anything goes on a pole or a car.

When a local business agrees to display your flyers, keep it a plain courtesy. If that business also sends you patients, or is a health care provider, paying it per patient or per referral raises the federal kickback questions covered in our grand opening guide. Have your attorney look at any arrangement that involves money or gifts.

What the flyer says: claims and offer terms

A flyer is advertising, so federal advertising law applies. 15 USC 45(a)(1) declares unfair or deceptive acts or practices in commerce unlawful. 15 USC 52 makes it unlawful to disseminate a false advertisement likely to induce the purchase of drugs, devices or services, which covers health services. The FTC’s Policy Statement on Deception (1983) explains that the FTC looks at the overall impression of an ad, including what it leaves out, from the view of a reasonable consumer.

For a small printed piece that means a few practical things. A claim such as “same-day appointments” or “we take your insurance” must be true for the readers who receive it. A price must say what it covers. An offer needs its terms on the piece itself: who qualifies, what is included, the end date and any conditions. A headline that says one thing while small print takes it back can leave the overall impression the FTC treats as deceptive. Results claims about a treatment need evidence before they go to print.

Health claims and specialty rules from state boards also apply to print. Our healthcare marketing rules guide covers the wider rules, and our QR code guide covers keeping required disclosures on the printed piece and making the page behind a code match the offer.

Free offers and Medicare or Medicaid patients

A neighborhood flyer reaches anyone at the door, including people on Medicare and Medicaid. 42 USC 1320a-7a(a)(5) allows civil monetary penalties against a person who offers or transfers remuneration to a person eligible for Medicare or a State health care program that the offeror knows or should know is likely to influence them to order or receive items or services paid for by those programs from a particular provider.

A free exam, a waived copay or a gift for booking can fall under that rule. The law and the HHS Office of Inspector General’s policy on gifts of nominal value are explained in our grand opening guide. For a flyer, we recommend one of three paths: offer only what the OIG treats as nominal value, limit the offer in writing to services not paid for by Medicare or Medicaid, or leave the offer out and promote the practice itself. Have your attorney review the wording.

No patients on the flyer without an authorization

A patient’s name, photo, story or before and after image on a flyer or a post is a use of protected health information for marketing. Under 45 CFR 164.508(a)(3), a covered entity must get a patient’s authorization for any use or disclosure of protected health information for marketing, with limited exceptions for face-to-face communications and promotional gifts of nominal value. A verbal yes in the exam room is not an authorization. The form has required elements set out in 164.508(c).

A real patient’s words on a flyer are also a testimonial under FTC rules. Our guide to patient testimonials covers the authorization and the FTC side together.

Patient addresses are protected health information too. If you plan to drop flyers on patient streets using your own records, that is a use of patient data under 45 CFR 164.502, and whether it is marketing depends on the definition in 164.501. We recommend building the delivery map from public geography, such as streets near the office, rather than from patient records.

Neighborhood apps: post as the business

Nextdoor updated its self-promotion policy on August 19, 2026. Promoting a business, service or paid opportunity must now be done from a free Business Page, not a personal neighbor account, and that covers posts and comments in the main feed as well as unsolicited direct messages. Nextdoor says the rule does not apply to its Groups, where admins decide what promotion is welcome. Its business help page says a verified business can post to the neighborhood newsfeed and choose the audience by radius or by neighborhood.

For a practice, that means one Business Page claimed by an owner or authorized representative, posts from that page, and no promotional posts or messages from the personal accounts of the doctor or staff. Read the platform’s current rules before you post, because platform policies change and a flagged post reaches fewer neighbors.

Staff recommending their own practice from personal accounts raises an FTC question as well. 16 CFR 255.5 says that when an endorser has a connection to the seller that might materially affect the weight of the endorsement and that the audience would not expect, the connection must be disclosed clearly and conspicuously, and it lists business relationships as an example. 16 CFR 465.5(a) makes it a violation for an officer or manager of a business to write a consumer review of it without clearly disclosing that relationship. Our guide to staff posting in forums covers employee posts in more detail.

Neighbors also post about practices: a question about wait times, a complaint, a thank you. Replying with any detail that confirms someone is your patient is a disclosure of protected health information under 45 CFR 164.502(a). Reply in general terms and invite the person to call the office. Our guide to responding to reviews covers the wording.

Questions to ask before the flyers go out

• Which cities and counties does the route cover, and what do their handbill, solicitation and litter codes say?
• Does any city on the route require a permit or license for commercial distribution?
• Do the people distributing know to skip mailboxes and homes with no handbill or no advertising signs?
• Is each claim on the piece true, and do we have evidence for it?
• Are the offer terms on the piece: who qualifies, what is included, the end date?
• Could the offer reach Medicare or Medicaid patients, and has our attorney reviewed it?
• Does the piece show any patient, and if so, do we have a signed authorization?
• Is our neighborhood app presence a Business Page, and do staff know not to promote from personal accounts?

Use and avoid

• Use: door hangers placed on the door or handed to the person at home, on unposted homes, secured so they do not blow away.
• Avoid: anything in, on, under or hanging from a mailbox.
• Use: a flyer that names the practice, its services, its address and how to book.
• Avoid: “best,” “painless” or results claims you cannot back with evidence.
• Use: offer terms printed next to the offer.
• Avoid: free exams or gifts aimed at Medicare or Medicaid patients without your attorney’s review.
• Use: a Nextdoor Business Page for practice posts.
• Avoid: staff promoting the practice from personal accounts without a clear disclosure.

An illustration

This example is invented. [Practice name], a family dental office, opens a second location and plans door hangers for the streets within a short walk. The office manager looks up the city code, finds a handbill section that bars leaving material at homes posted with a no advertising sign, and writes that into the brief for the two staff members delivering on a Saturday. The brief says: door handle only, never the mailbox, skip any posted home, take the hanger back if someone at the door says no thanks.

The first draft of the hanger says “Free exam for new patients.” The attorney asks whether the offer could reach patients on Medicaid, which the office accepts, and the practice changes the hanger to describe its services and hours with no free offer. A staff member offers a photo of their child’s smile for the hanger. The practice keeps the photo off, because it would need a signed authorization and the hanger works without it. The same week, the office claims its Business Page on the neighborhood app, posts the opening from that page, and asks staff not to post about it from their personal accounts.

Checklist

• Local handbill, solicitation and litter codes checked for each city on the route.
• Permit or license obtained where a city requires one.
• Written brief for distributors: no mailboxes, skip posted homes, secure the hanger.
• Each claim checked for truth and evidence.
• Offer terms printed on the piece.
• Free offers reviewed against 42 USC 1320a-7a(a)(5) by your attorney.
• No patient names, photos or stories without a signed 164.508 authorization.
• Delivery map built from public geography, not patient records.
• Neighborhood app Business Page claimed, staff told not to promote from personal accounts.
• Replies to neighbor posts kept general, with no confirmation of patient status.

How we help

We build practice websites, local SEO, Google Ads and lead generation and an AI front desk for independent practices. For neighborhood promotion, we help write flyer and post copy for your attorney to review, set up a landing page and tracking that do not collect health details, and route calls and booking requests from the piece to the front desk. 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 guide.

Sources

• 18 USC 1725: Postage unpaid on deposited mail matter
• USPS Domestic Mail Manual 508: Recipient Services (part 3.1, mail receptacles)
• USPS v. Council of Greenburgh Civic Associations, 453 U.S. 114 (1981)
• Breard v. City of Alexandria, 341 U.S. 622 (1951)
• Watchtower Bible and Tract Society v. Village of Stratton, 536 U.S. 150 (2002)
• City of Tempe: Handbills (Tempe City Code sections 3-21 and 3-22)
• San Francisco Public Works: Unwanted handbills and newspapers (posted October 7, 2024)
• Nextdoor: Changes to self-promotion policy (August 19, 2026)
• Nextdoor Business: How to post as a business
• 15 USC 45: Unfair methods of competition and unfair or deceptive acts
• 15 USC 52: Dissemination of false advertisements
• FTC Policy Statement on Deception (1983)
• 42 USC 1320a-7a: Civil monetary penalties
• 16 CFR 255.5: Disclosure of material connections
• 16 CFR 465.5: Insider consumer reviews and consumer testimonials
• 45 CFR 164.501: Definitions (marketing)
• 45 CFR 164.502: Uses and disclosures of protected health information, general rules
• 45 CFR 164.508: Uses and disclosures for which an authorization is required

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