What consent actually requires before you text a patient

October 5, 2026Austin Bond

If you have read anything about text message consent in the last two years you have probably seen the phrase “one-to-one consent,” usually with some urgency attached.

The situation is less dramatic than the headlines, and the practical advice has barely changed. Here is the current state.

What happened

In December 2023 the FCC adopted rules that would have required consent to name no more than one identified seller, and to be logically and topically connected to the interaction that produced it. That was the one-to-one rule. It was due to take effect in January 2025.

On 24 January 2025, the Eleventh Circuit vacated those amendments in Insurance Marketing Coalition v. FCC, holding that the FCC had exceeded its authority. The practical effect is that the previous standard, in place since 2012, still governs.

So the rule everybody prepared for is not in force. The underlying requirement always was, and still is.

What the standard actually requires

For marketing messages sent with automated technology, you need prior express written consent. In plain terms that means the person agreed, in writing, before you messaged them, and the agreement was clear about what they were agreeing to.

A compliant consent typically shows:

Who is sending the messages, by name
That the messages may be marketing
That automated technology may be used
That consent is not a condition of purchase
That message frequency varies and rates may apply
How to stop, and how to get help

Note that “in writing” includes a checkbox on a web form. It does not have to be a signature on paper.

What this looks like at a dental practice

Two places matter, and they are different.

Your intake forms. This is where you collect consent to text your own patients about their own appointments. The wording should name your practice, not a vendor.

Any web form that collects numbers. If you run ads to a landing page, the consent box lives there, and the brand named in it has to be the brand that actually sends the texts.

That second point is where it connects to carrier registration. Your A2P campaign has to describe the opt-in accurately, and the brand on the opt-in page has to match the brand on the registration. Get those out of step and messages get filtered regardless of how good your consent language is. That is a separate problem worth understanding.

Three things practices get wrong

Treating consent as transferable. A patient who consented to texts from your practice has not consented to texts from a marketing company. Consent belongs to the named sender.

Making it a condition. If a patient has to tick the box to get the appointment, the free report, or the discount, the consent is not clean. Leave it optional and leave it unticked.

Not keeping the record. You need to be able to show what the person agreed to and when. The wording changes over time, so store the exact text that was on screen, not a reference to it.

Our own report form does this. The box is unticked, the report arrives whether or not you tick it, and the submission records the exact consent wording along with a timestamp. You can read the full programme terms including STOP and HELP.

The honest caveat

I am not a lawyer and this is not legal advice. TCPA litigation is an active area with real financial exposure, and state laws add requirements on top of the federal ones. Before you text patients at scale, have your attorney look at your actual intake language.

What I can tell you is that the practices that get into trouble are rarely the ones that read a post like this. They are the ones who bought a list, or who let a vendor text under their own brand without checking.

If you want to see what your lapsed list is worth before you work out the texting side, the report takes about two minutes and asks for counts only.