Overview 📝
This article covers two connected topics: the compliance standards that apply to all patient text messages sent through ChiroHD, and the step-by-step process for managing a patient's SMS opt-in or opt-out status. Understanding both is important — compliance rules determine when an opt-out notice is required in your messages, and the opt-in/opt-out workflow determines whether a patient can receive texts at all.
Where to Find Patient SMS Settings
To view or change a patient's SMS status:
Open the patient's profile (select from the patient list or search by name)
Look at the header area of the patient profile — the current status displays as a button labeled "Text Opt-In: [STATUS]"
Click the button to open the status dropdown and select a new status
Opt-Out Status
⚠️ Important: A patient with Opted Out status cannot receive any text messages from your office — this includes appointment reminders, missed appointment notifications, mass texts, automated messages, and any message sent manually from the patient's messaging tab.
Compliance Requirements for All Text Messages
When an Opt-Out Notice Is Required
Any message that includes marketing or promotional language must include an opt-out. This applies to texts about patient appreciation, giveaways, events, seminars, dinners, or any other promotional communication.
✅ Required opt-out wording example:
"Text STOP to opt out."
Standard appointment reminders that simply identify the office, date, and time do not require an opt-out — they are transactional, not promotional.
✅ Compliant reminder example:
"Hi John, this is Lisa's Chiro Office reminding you of your appointment on Thursday, 10/20/25, at 3 PM. Reply YES to confirm."
🚫 Non-compliant message example (vague, motivational, no office identification):
"Hey Joe, it's Dr. Spinal! Let's get your body back to healing and feeling its best. Keep your body strong with regular adjustments! Your next adjustment awaits!"
💬 Always explain to patients that opting out removes them from all text communications — not just marketing messages. Many patients believe they are only opting out of promotional texts.
Message Content Best Practices
Keep messages concise — under 320 characters when possible
Include your office name at least once per message or thread
Limit emojis to 1–3 maximum — too many can trigger carrier filtering or encoding issues
Avoid excessive punctuation, slang, or spam-like formatting (multiple exclamation marks, ALL CAPS, emoji strings)
Do not use public URL shorteners (bit.ly, tinyurl, etc.) — use full or branded links only
Prohibited Topics
Messages containing any of the following may be blocked by carriers or cause your messaging campaign to be terminated immediately:
🚫 Sexually explicit or suggestive content
🚫 Hate speech or discrimination
🚫 Alcohol, firearms, tobacco (including vaping)
🚫 Drugs or CBD/gummies
🚫 Phishing, scam, or impersonation attempts
⚠️ A single phishing-style message can trigger immediate filtering and campaign termination.
Deliverability Best Practices
Send during normal hours (8 AM–8 PM local time)
Avoid sending large volumes of messages in rapid succession
Always secure patient consent before sending texts
Opting a Patient Out of Texts 🚫
Fully opting a patient out is a two-step process. Both steps are required — completing only one will leave the patient's status mismatched between ChiroHD and the carrier.
Step 1 — Patient action: The patient texts STOP to your office's Twilio texting number. This tells the carrier to stop all texts from that number.
📋 Other opt-out keywords: Patients can also trigger an opt-out by texting CANCEL, END, QUIT, or UNSUBSCRIBE. Any of these words will opt them out automatically at the carrier level. STOP is the only keyword that cannot be adjusted. If your office is seeing accidental opt-outs from patients texting "cancel" to cancel appointments, contact ChiroHD support — certain keywords can be adjusted per location.
Step 2 — Office action:
Open the patient's profile
Click the "Text Opt-In: [STATUS]" button in the profile header
Select OPTED OUT from the dropdown
Save the change
Opting a Patient Back In to Texts ✅
If a patient previously opted out and wants to receive texts again, both steps must be completed before messages will deliver.
Step 1 — Patient action: The patient texts START to your office's Twilio texting number. This re-enables messages at the carrier level.
⚠️ The patient must text START first. Even if the office updates the profile to Opted In, messages will not deliver until the patient has re-subscribed by texting START. This is the most common reason a re-opt-in fails.
Step 2 — Office action:
Open the patient's profile
Click the "Text Opt-In: [STATUS]" button in the profile header
Select OPTED IN from the dropdown
Save the change
Sending an Opt-In Request to a Patient 📨
If a patient's status is Not Initiated or Awaiting Response and you want to collect consent, ChiroHD can send an opt-in request text directly from the patient profile.
Open the patient's profile
In the sidebar, look for the "Text opt-in" button — this button only appears when the patient's status is Not Initiated or Awaiting Response and they have a phone number on file
Click the button and confirm the prompt
ChiroHD sends the patient an opt-in request text
The patient's status updates to Awaiting Response
Once the patient replies START, their status updates to Opted In
Key Takeaways ✅
Marketing messages must include an opt-out notice — appointment-only reminders do not
Avoid SHAFT topics (Sex, Hate, Alcohol, Firearms, Tobacco) — these can terminate your messaging campaign
Keep messages under 320 characters, limit emojis to 1–3, and always include your office name
Do not use shortened URLs (bit.ly, tinyurl) — use full links
There are four SMS statuses — Not Initiated, Awaiting Response, Opted In, and Opted Out
Opting out and opting back in both require two steps: one from the patient (STOP or START) and one from the office (updating the profile dropdown)
The patient must text START before the office updates the profile, or messages will not deliver
Opted Out patients cannot receive any texts — reminders, automated messages, manual messages, or mass notifications
Patients texting "cancel" to cancel an appointment can accidentally trigger an opt-out — contact support if this is an issue at your location
Always explain to patients that opting out affects all texts, not just marketing messages
Conclusion 📌
Use this article when a patient asks to stop receiving texts, when you need to re-enable texts for a patient who previously opted out, or when you are unsure whether a message requires an opt-out notice. If both the patient action and the office action have been completed and texts are still not sending, check the patient's profile for a delivery error indicator or contact ChiroHD support.