What is TCPA consent?
TCPA consent is the permission a business needs under the Telephone Consumer Protection Act before placing certain calls or texts using an autodialer, artificial voice or prerecorded voice. For telemarketing and promotional texts to cell phones, the standard is prior express written consent. Healthcare messages have narrower rules of their own, and states can add more.
- Marketing texts and robocalls to cell phones generally need prior express written consent.
- Some healthcare messages, like appointment reminders, can rely on lighter consent under FCC rules, within limits.
- Consumers can revoke consent by any reasonable means; honor opt-outs fast.
- TCPA damages are $500 per violation, up to $1,500 if willful, and class actions are common.
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What TCPA consent means
The TCPA, passed in 1991 and enforced by the Federal Communications Commission (FCC), restricts calls and texts made with an automatic telephone dialing system or an artificial or prerecorded voice. The FCC treats text messages as calls for this purpose.
There are two main consent levels. Prior express consent, which can be oral or written, covers many informational messages. Prior express written consent is required for telemarketing and advertising messages to cell phones, and for prerecorded telemarketing calls to landlines. Written consent must be signed (electronic signatures under the E-SIGN Act count), identify the number, and clearly disclose that the person agrees to receive marketing messages by automated means and that consent is not a condition of purchase.
The FCC has exempted certain healthcare messages from some requirements, such as specific types of free-to-the-patient calls and texts about appointments, prescriptions and care, subject to conditions like volume limits and an easy opt-out. Promotional messages do not fit these exemptions.
How it applies to practice marketing
- Forms: add a separate, unchecked consent box with clear text for marketing texts. Do not bundle it into terms of service.
- Records: keep the consent language, timestamp, page and number for each opt-in.
- Separate streams: keep reminders and care messages apart from promotions.
- Opt-outs: process STOP replies and other reasonable revocation requests across every system.
- Quiet hours and state rules: some states, such as Florida and Oklahoma, have their own telemarketing laws with extra limits.
Carriers also require 10DLC registration for business texting. Our TCPA healthcare SMS guide and med spa SMS guide go deeper.
Common mistakes and limits
The biggest mistake is assuming a patient relationship equals marketing consent. A patient giving a phone number for appointments has not agreed to promotional texts. Others include buying lead lists, texting old enquiries without valid consent records, and letting opt-outs in one tool fail to reach another.
TCPA rules change through FCC orders and court decisions; a 2025 appeals court decision vacated the FCC's one-to-one consent rule, for example. HIPAA, which governs PHI, applies at the same time. Consent also has to be provable: if a patient disputes an opt-in, the practice needs the record, not just a belief that the form was compliant. Have your compliance or legal team review consent language before launching a texting program.
Related pages from the US team
TCPA healthcare SMS guide
Consent, content and opt-out rules for practices.
Med spa TCPA SMS guide
Texting rules for aesthetic practices.
Patient email and SMS marketing
How Ichelon Consulting US runs compliant messaging.
US healthcare marketing glossary
Every term, defined in plain English.
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We benchmark your last 90 days, agree monthly goals with you, and track them live on Ichelon Agency OS with a report every Monday. Performance-Linked Payout Models are available. Our US leadership is based in Dallas, and strategy calls run in US business hours.
Common questions
Do appointment reminder texts need TCPA consent?
They generally need at least prior express consent, which patients often give by providing their number for care. The FCC has exempted certain healthcare messages from stricter rules if conditions are met. Promotional content mixed into reminders can lose that treatment and require prior express written consent.
What is prior express written consent?
It is a signed agreement, electronic signatures included, that authorizes a business to send marketing calls or texts to a specific number using automated technology. It must clearly disclose what the person is agreeing to and state that consent is not required to buy anything.
Can a practice text people who filled in a web form?
Only if the form captured the right consent. For marketing texts, the form should include clear consent language and a separate opt-in. A form that only says "we will contact you" may not support automated promotional texting.
What are TCPA penalties?
The TCPA allows statutory damages of $500 per violating call or text, up to $1,500 per violation if the violation is willful or knowing. Because each message counts, class actions can lead to large exposure. State telemarketing laws can add their own penalties.
A note on this guide: it explains marketing practice, not legal advice. Rules on privacy, advertising and insurance change and vary by state, so confirm anything compliance-related with your own counsel.
Is your texting program built on clean consent?
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