Keep in touch.
Give people a reason to return.

There’s no fixed number that’s safe for every practice — the honest answer depends on the segment, not the list as a whole. A recently active patient who opens most emails can handle more frequent contact than someone who hasn’t engaged in months; sending both groups on the same weekly schedule wears out the engaged group and drives the disengaged one to unsubscribe or, worse, mark the message as spam. That complaint rate matters more than most practices realize, because mailbox providers track it at the sending domain level — enough complaints and every campaign from that domain gets treated with more suspicion, including the ones going to people who actually want them. The practical rule is to let engagement set the pace, not a fixed weekly calendar.

Landing in spam is usually a trust problem, not a content problem — mailbox providers are deciding whether to believe a message came from who it claims to, and the three records fix three different pieces of that decision. SPF lists which mail servers are allowed to send on the domain’s behalf. DKIM attaches a cryptographic signature that proves the message wasn’t altered in transit and really did originate from the claimed domain. DMARC sits on top of both and tells the receiving server what to do when a message fails either check — quarantine it, reject it, or let it through — and gives the domain owner visibility into how often that’s happening. None of the three touches subject lines, sending frequency, or whether recipients actually want the message; a domain can pass all three checks and still land in spam over poor engagement. What they fix is impersonation and forgery, not the whole of deliverability.

Being an existing patient doesn’t by itself create legal permission to send marketing texts — TCPA requires consent for that specifically, a different bar than the implied consent that covers something like an appointment reminder. A patient has to affirmatively agree to receive marketing messages, typically captured at intake or through an opt-in on a form, and that consent needs to be documented, not assumed because a phone number exists in the chart. A2P registration is a separate requirement layered on top of consent: carriers require any business sending text campaigns at volume to register its sending number through the 10DLC system, and unregistered traffic gets filtered or blocked outright regardless of consent. Both pieces have to be in place — consent makes the message legal, registration makes it deliverable.

We write them, on your platform account, in a voice built from how the practice actually talks to patients — not a generic template with the clinic’s name dropped in. That includes the segmented campaigns and the win-back sequences, scheduled and sent without someone on staff drafting copy between patients. Anything needing a clinician’s precision — dosage language, claims that touch regulated territory — gets reviewed before it goes out, and the practice can see and approve any campaign in advance if that’s how it wants to work. What we don’t do is hand over a blank template and leave the writing to whoever’s free that week.