They stop when the sequence checks for three exits: a booking, a reply, and an opt out. In GoHighLevel a Customer Booked Appointment trigger removes the patient from the follow up workflow, Stop on Response ends it when the patient replies, and an opt out workflow ends all messaging. The bottom line: a patient who has already booked should never get a third reminder to book, and each exit should be tested, because a phone booking is the one most often missed.
The three exits
| Exit | How it works | Gap to watch |
|---|---|---|
| Patient books online | The Customer Booked Appointment trigger removes the contact from the follow up workflow | Works only for bookings made in the connected calendar |
| Patient replies | Stop on Response ends the workflow for that contact | Does not catch phone calls |
| Patient texts STOP | An opt out workflow adds the tag Opted out and removes the contact from all messaging | Must be honored immediately under the healthcare exemption |
GoHighLevel's help pages say Stop on Response stops the workflow for the contact who replies and does not catch phone calls. So the front desk needs a way to end the sequence when someone books by phone: a tag, such as Booked by phone, that an If/Else step checks before each message.
Frequency limits
The FCC's 2015 healthcare exemption lets HIPAA covered entities and their business associates send certain treatment messages, such as appointment and exam reminders, without prior express consent, but only under conditions. Law firm summaries list them: the message goes only to the number the patient provided, states the provider's name and contact information, has no marketing, billing, or debt collection content, complies with HIPAA, is concise (160 characters or less for a text), is limited to one message a day and three a week per provider, offers an easy opt out, and every opt out is honored immediately. The FCC also said the calls must be free to the end user, not charged against the patient's plan, which many practices cannot guarantee. Because of that, many practices also collect consent and treat reminders as informational messages.
Even outside the exemption, a follow up sequence with more than one message a day is a risk. A sequence for an unscheduled treatment plan or a recall visit can be two or three messages over three weeks, with a call task between them.
A sample sequence with exits
| Day | Step | Exit check before sending |
|---|---|---|
| 0 | Text with a booking link | None |
| 3 | Second text | Booked, replied, opted out, Booked by phone |
| 10 | Email with the link | Booked, replied, opted out, Booked by phone |
| 14 | Call task for the front desk | Booked, replied, opted out, Booked by phone |
| 21 | Final text, then end | Booked, replied, opted out, Booked by phone |
Build it in GoHighLevel
HighLevel help center pages describe the Appointment Status trigger as firing when an appointment is created or its status changes, with statuses New, Confirmed, Cancelled, Showed Up, No Show, and Invalid, and with filters for calendar, calendar group, tag, user, and who made the change (customer, user, or API). The Update Appointment Status action can set the same statuses from inside a workflow. A third party agency guide adds that Appointment Status is now the main appointment trigger and the older Customer Booked Appointment trigger is being phased out, so use Appointment Status for new builds.
- Turn on Stop on Response in the follow up workflow settings.
- Build a workflow with the Customer Booked Appointment trigger for all calendars that uses the Remove from Workflow action to take the contact out of the follow up workflow.
- Add an If/Else before each step that checks the tags Booked by phone and Opted out.
- Teach the front desk to add Booked by phone when they book a patient by phone, or set the step to run from the practice system's status if it syncs.
- Build an opt out workflow for the stop words that removes the contact from every messaging workflow and logs the time.
- Test all three exits with a test contact every month.
Worked example
For example, a practice sends a 4 step sequence to 100 patients a month, so up to 400 messages. If 40 patients book after the first text and the exits work, the practice avoids 120 messages (40 times 3) that would have gone to people who already booked.
Mistakes to avoid
- Assuming a phone booking stops the sequence. It does not.
- Sending more than one message a day. That leaves the exemption.
- No test. Test each exit monthly.
- Clinical detail in the texts. Keep them generic.
How this was handled before
A front desk worker kept a list of unscheduled treatment and crossed names off by hand when patients booked. Automated sequences removed the list, and exit checks put the crossing off back in.
What to measure after launch
Track sequence starts, patients who booked, messages sent after a booking, and opt outs honored immediately. Test every exit with a test contact each month.
Check before you switch it on
US text messages sent from a standard 10 digit number need A2P 10DLC registration. The HighLevel support portal says registration is required for texts to US recipients from 10 digit long code numbers and that toll free numbers do not require it. HighLevel's opt in guidelines also say a person cannot be forced to agree to text messages in order to submit a form, so keep the consent box optional. One compliance guide separates informational texts, which need documented consent, from marketing texts, which need prior express written consent. Ask your attorney which category your reminders fall into. Keep a record of each opt out and when it was honored, and have counsel confirm the consent approach. This is general information, not legal advice.
Questions people ask
Does Stop on Response catch phone calls?
No. GoHighLevel's help pages say it does not.
What stops the sequence when a patient books online?
A workflow with the Customer Booked Appointment trigger and a Remove from Workflow action.
How many messages can a practice send under the exemption?
One a day and three a week per provider, with an easy opt out honored immediately.
Ready to try it yourself? Start a GoHighLevel account here.
You can also see this in action in our GoHighLevel capabilities demo.