If a patient mentions they are not getting notifications, you can always understand why ✨
This article walks through exactly how to verify what was sent, and the most common reasons a patient or staff member may not have received a notification.
Step 1: Check the Appointment Notification History
This is always your first step. Before troubleshooting anything else, check whether the notification was actually sent by the system.
Open the Schedule or Homepage
Click directly on the appointment in question to open Appointment Details
Scroll down to the Notification History section
Review the full list of email and SMS notifications, including the date and time each was sent
📌 If a notification appears in this history, it was sent by our system. The question then becomes why the patient or staff member didn't receive it — which the sections below will help you resolve.
📌 If no notification appears in the history, it means the system did not send one. The most common reason is that notifications were not enabled for that patient at the time of booking.
Step 2: Check the Patient's Notification Settings (the "bell icon" 🔔)
Look at the bell icon in the upper-left corner of the patient's chart. The color tells you the current state of their notification settings at a glance:
🟢 Green — All notifications are turned on
🔴 Red — All notifications are turned off
🟡 Yellow — Notifications are partially enabled
Click the bell icon to see the exact breakdown of what is and isn't enabled for that patient.
⚠️ Important: A green bell means notifications are currently turned on — but it does not guarantee they were turned on at the time of the original booking. A patient may have booked with notifications off and enabled them later. In that case, no reminders would have gone out for that appointment.
Why a Patient May Not Have Received Notifications
1. Notifications Were Not Enabled at the Time of Booking
This is the most common cause. Patients must consent to and enable notifications in order to receive them.
Brand new patients booking through the portal for the first time will automatically receive a new appointment confirmation, and are then prompted to activate their notification preferences right there in the portal - it's the first thing we do!
Existing patients (imported, added manually, or returning) must manually enable their notifications from the patient portal. If they haven't done this, they will not receive reminders. The staff can turn them on for all patients in bulk from the "import data" settings page.
When a patient books an appointment on their own through the portal, they are encouraged to turn on notifications — but not required to. If they skip this step, no reminders will be sent. Please note: It would be a HIPAA violation to require a patient to receive notifications..
2. The "Hush" Option Was Selected When Booking
When a staff member creates an appointment, there is a prominent checkbox available to suppress notifications for that specific appointment. This is commonly used when the patient is standing right there at the desk, since there's no need to send a confirmation for an appointment just made in person.
If this box was checked, the "new apt" notification will not be sent for that appointment, regardless of the patient's general notification settings. The reminders are sent, just not the "new appointment" notification.
3. The Patient's Email Notifications Are Being Filtered or Blocked
Even when our system sends a notification, the patient's email provider may intercept it. Things to check with the patient:
Check the spam or junk folder — Our notifications are transactional (not marketing), which gives them an extremely high delivery rate. However, some email providers may still flag them.
Check if our sender was blocked — If a patient has ever clicked "Block sender" or "Report spam" on one of our emails, future notifications will be filtered automatically.
Check that the email address on file is correct — It's possible the address was entered incorrectly or has since changed.
4. SMS Notifications Are Being Filtered on the Patient's Phone
For text message reminders, two things commonly prevent delivery:
Unknown sender filtering — Many phones are configured to filter messages from unknown numbers into a separate folder. This is especially common on iPhones. The patient may need to look in a separate "Unknown Senders" list and tap Mark as Known so future messages appear normally.
The patient replied STOP — If a patient has ever replied "STOP" to any of our text messages, all SMS notifications to that number are permanently blocked until they opt back in.
To re-enable SMS after a STOP reply, the patient should text the word START to our notification number: +1 (415) 942-5477. Once they send START to that number, SMS reminders will resume.
5. Not Enough Lead Time for the Reminder to Send
Reminders are triggered based on the gap between when an appointment is booked and when it is scheduled to occur.
If an appointment is booked same-day or just a few hours before, there may not be enough time for a 24-hour reminder — or any multi-day advance reminder — to fire. For example, if a patient books at 1:00 PM for an appointment at 9:00 AM the next morning, a reminder set to send 24 hours in advance would have already passed before the appointment was even created.
This is expected behavior — it is simply a timing gap, not a malfunction.
Section B: Why a Staff Member May Not Have Received Notifications
The "Don't Notify Own Actions" Setting
Go to Settings → Staff Notifications and click Edit next to the relevant staff member.
There is a prominent checkbox: "Don't notify own actions when making, editing, or cancelling appointments."
This setting is intentional. When a practitioner books an appointment themselves, they already know they've done it — there's no need for a redundant confirmation email.
With this setting enabled: The practitioner will not receive notifications for appointments they create themselves, but will receive notifications for appointments created or changed by patients or other staff members.
With this setting disabled: The practitioner will receive notifications for all appointment activity, including their own.
💡 If a practitioner is not receiving notifications for appointments they booked themselves, this setting is almost always the reason.
Section C: Best Practices for Staff
When Onboarding a New Patient Over the Phone
Rather than turning all notifications on at full volume for a new patient, it's good practice to ask directly during the call:
"Is it okay if we send you appointment reminders by email and/or text? Do you have a preference?"
Then configure their notification settings to match before creating the appointment. This prevents both missed notifications and notification fatigue — where a patient receives so many reminders that they start blocking them entirely.
How Patients Can Adjust Their Own Notifications
Patients have full control over their notification preferences at any time — and they don't need to log in to make changes.
Any reminder email or text they receive includes a link that takes them directly to their notification preferences, where they can toggle individual notification types on or off with a single click. This makes it easy for patients to receive only the reminders that are helpful to them.
Quick Reference: Notification Troubleshooting Checklist
For staff to check first:
Open the appointment → scroll to Notification History → confirm whether notifications were sent
Check the bell icon on the patient's chart (green / yellow / red)
Verify the patient's email address and phone number on file are correct
Review staff notification settings and confirm the "Don't notify own actions" checkbox status
Questions to ask the patient:
Have you checked your spam or junk mail folder?
Have you ever clicked "Block sender" or "Report spam" on a message from us?
Are you filtering messages from unknown numbers on your phone?
Have you ever replied STOP to a text from us? If so, text START to +1 (415) 942-5477 to re-enable.
If you've worked through all of the above and notifications are still not arriving as expected, reach out to our support team and we'll investigate further with you.