SMS Settings

What Is an SMS Inbox?

An SMS Inbox contains messages sent between patients and staff through SMS, or text message. 

With Fold, you can use your landline or clinic number to directly send SMS communication to patients. 

Multiple phone numbers can be integrated with Fold. Each phone number:

• Has its own SMS inbox

• Can be configured so specific staff members have access

This allows clinics to route messages efficiently across teams or locations.

Inbox Permissions

Inbox permissions are managed at: Settings → Messages → Inboxes

1. Select the phone number associated with the inbox.

2. Click the pencil (edit) icon on the far right.

3. Add or remove users from the Collaborators list. Collaborators are users who can receive incoming SMS messages and send outgoing SMS messages from the selected phone number.

Enabling Rotational Assignment will randomly assign incoming messages to collaborators in the inbox. Fold recommends enabling this feature only when multiple collaborators share responsibility for monitoring and responding to a single inbox.

Auto Replies

To create an auto reply for an SMS inbox:

1. Navigate to Settings → Calls

2. Select the phone number

3. Click the Edit icon

4. Scroll to Option #6

5. Add the auto-reply message

Auto-reply behavior depends on how the phone number is assigned:

• Assigned to a staff member: The out-of-office reply follows the staff member’s schedule.

• Assigned to a location: The out-of-office reply follows the location’s office hours.

SMS Character Limits

• The maximum SMS length is 1,600 characters

• Special characters count as multiple characters and can reduce the usable limit

To ensure reliable delivery, Fold recommends keeping messages between 1,550 and 1,575 characters.

SMS Policies

Per Twilio and carrier policies, messages must have sender identification and opt-out information. Otherwise, messages can be flagged and will not be sent. 

• Sender Identification: The message should state who the sender is. We recommend sending this when beginning a new message to the patient (even if you have had previous communication with the patient via SMS). For example:
  • This is Dr. Smith's Clinic
  • Sent by XYZ Clinic
• Opt-Out: The message needs to tell the recipient how to stop receiving messages. We recommend sending this at least once during a conversation and at the beginning of a new message. For example:
  • Reply STOP to unsubscribe
  • Text STOP to opt out. By responding "STOP" you will be opting out of all communication from this number, including appointment reminders, medication refills, etc.

Patient consent must be obtained before sending PHI via SMS.

FAQ

• What happens if two patients or a patient and a prospect share the same phone number?
  • In situations where two patients share the same phone number, a warning message prior to sending an SMS will pop up advising the sender that another person is registered in Fold with the same SMS number. The warning message will explicitly state where the message will be stored.
• Can a clinic have multiple SMS inboxes? Can multiple clinics share an SMS inbox?
  • Yes, multiple SMS numbers can be used in a single clinic (divide staff members accordingly or all staff can answer all inboxes). Yes, a single SMS inbox can be shared across multiple physical locations.  
• Can a patient opt out of SMS communication?
  • Yes, patients can opt out of SMS communication on a number-specific basis. To do so, they can reply "STOP" to any SMS message they receive from Fold. Once they opt out for a specific number, they will no longer receive SMS messages from that number. To re-enable SMS communication for that number, they can reply "START" to the same number. Within Fold, staff members will see a visual notification that the patient has blocked SMS communication from the designated SMS inbox.
  • Note: Opting out of SMS will not affect email communication. Patients can unsubscribe from specific email categories (General, Care Plan Suggestions, Conversation Engagement) by following the unsubscribe link in the email.