Text messaging is one of the most effective ways to reach your patients, but it comes with rules. Carrier and legal requirements—like the Telephone Consumer Protection Act (TCPA) in the U.S. and similar rules in Canada—exist to protect consumers from unwanted messages. Following them keeps your messages from being blocked, protects your sending reputation, and builds trust with your patients.
This overview covers the two pillars of compliant SMS in Aesthetix CRM: giving patients a clear way to opt out, and clearly identifying your practice (your sender ID). As the practice sending messages, you are responsible for obtaining proper consent and honoring opt-outs.
For deeper legal guidance, see the SMS & TCPA Compliance guide in the Compliance collection, along with the TCPA Checklist, Texas SMS Marketing Compliance (SB 140), SMS Marketing Opt-Out, and Enhanced Terms & Conditions for Compliance articles.
Bulk SMS messages are also screened in real time against a list of medication and product names that mobile carriers block. For the full list of blocked terms and compliant rewrites, see Prohibited Words in Bulk SMS.
Legal requirements: The TCPA in the U.S. and comparable rules in Canada require that businesses give people a clear way to opt out of receiving text messages.
Trust and deliverability: Including opt-out instructions and identifying your practice reduces complaints and increases the chance your messages are delivered.
Carrier compliance: Mobile carriers enforce these rules as part of A2P 10DLC registration. If you don't follow them, your messages may be blocked or your account suspended.
Always provide clear opt-out instructions. Every campaign should include a simple opt-out method, such as "Reply STOP to unsubscribe." This is required under U.S. carrier rules.
Include opt-out language regularly. Add opt-out text to the first message you send, and repeat it at least once a month for ongoing campaigns.
Use standard keywords. Carriers automatically recognize opt-out keywords like STOP, UNSUBSCRIBE, CANCEL, and QUIT.
Process opt-outs immediately. When someone replies with an opt-out keyword, stop messaging them right away. Send a confirmation such as "You have been unsubscribed. Reply START to resubscribe."
Respect consent. Only message patients who have agreed to receive texts. For long-standing contact lists, check in roughly every 18 months to confirm they still want to hear from you.
Always include your practice name. Mention your business name in your messages, especially if you use a phone number patients might not recognize. For example: "Hi, this is Aesthetix Med Spa with your appointment reminder."
Be transparent and consistent. Use a sender ID patients will recognize. If you use shared or rotating numbers, including your practice name in every message is even more important.
Aesthetix CRM's SMS and MMS messaging runs over the same national carrier networks every business texting platform uses, so carrier content rules apply no matter who sends the message. Some categories are blocked outright, regardless of whether the recipient has opted in.
Content prohibited for SMS and MMS in the U.S. and Canada:
Phishing, smishing, or social engineering: messages designed to trick a patient into sharing credentials, payment details, or other sensitive information.
High-risk financial services: payday loans, third-party loans, or cryptocurrency offers.
Third-party lead generation: buying, selling, or sharing patient contact information with outside companies.
Debt collection or credit repair messaging sent on behalf of a third party.
"Get rich quick" schemes: work-from-home offers, high-risk investment pitches, or pyramid schemes.
Illegal or restricted substances: cannabis and CBD messaging are blocked by carriers even in states where these products are legal, and this also covers marketing prescription medications directly by text.
Gambling: casino or gambling-related content.
S.H.A.F.T. content: sex, hate, alcohol, firearms, and tobacco. Alcohol messaging (for example, promoting a med spa happy hour) may be allowed with proper age-gating; firearms and vaping content are not allowed at all.
Med spas most often run into this with skincare or wellness products that contain CBD, or with GLP-1/weight-loss and other prescription treatments. If a campaign mentions a controlled or prescription substance by name, send that content by email instead of SMS.
Carrier fines for violations. Major carriers, T-Mobile in particular, treat prohibited content as a "Severity 0" violation, their most serious tier, and can issue a fine on top of blocking the message: up to $2,000 for phishing or social engineering, $1,000 for other illegal content, and $500 for other policy violations such as S.H.A.F.T. content sent without proper age-gating. These fines apply per incident and are separate from any number suspension.
Do not hide opt-out instructions. Keep them easy to find and clearly worded.
Do not use unregistered sender IDs. Where registration is required, only use approved sender IDs.
Do not continue messaging people who have opted out. Once someone unsubscribes, do not message them again unless they opt back in.
Do not try to evade spam filters. Intentionally misspelling opt-out keywords, or sending the same or similar message from many different numbers to dodge detection (known as snowshoeing), is against carrier policy and can get your numbers blocked.
Aesthetix Med Spa: Your monthly update is here. Reply STOP to unsubscribe.
This message clearly identifies the sender and provides a simple opt-out option.
Do I have to include "Reply STOP to unsubscribe" in every message?
No, not in every message. It must appear in your first message and should be repeated regularly—at least once a month. This keeps you compliant and keeps your patients informed.
What happens if someone replies STOP?
Once someone replies with a standard opt-out keyword (like STOP, CANCEL, or UNSUBSCRIBE), you must immediately stop sending them messages. You should also send a confirmation letting them know they've been unsubscribed.
What happens if I don't follow these best practices?
If your messages don't meet carrier or legal requirements, they may be blocked, filtered as spam, or your messaging account could be suspended. It can also damage your practice's reputation with patients.
What kind of message content is prohibited or restricted?
Carriers block certain categories outright, including phishing and social engineering, high-risk financial offers, debt collection, gambling, illegal or restricted substances (including cannabis and CBD even where legal), and S.H.A.F.T. content (sex, hate, alcohol, firearms, tobacco). See the Prohibited and Restricted Message Content section above for the full list.
What happens if a message triggers a carrier fine?
Major carriers like T-Mobile can issue a fine, typically $500 to $2,000 depending on severity, on top of blocking the message or suspending the sending number. Review campaign content against the prohibited categories before sending, especially anything mentioning a substance, financial offer, or prize.
Where can I find current pricing?
For current pricing, see the pricing page.
