Therapy Inquiry Response Times: A Reply Standard

For OT, PT and SLP practices seeing children, adults or both, a reply standard is the written promise your team can keep: which inquiry channels you answer, how soon a person replies on each, who owns each channel and who covers, what the first reply says, where clinical questions go, and how you measure it weekly.

Key takeaways

A reply standard names, for each channel, the hours it is watched, the target time to a first human reply, the owner and backup, what the first reply contains and when to escalate.
When a patient starts an email exchange, HHS says the provider may assume email is acceptable unless the patient says otherwise, and may explain the risks of unencrypted email and let the patient decide.⁠²
HHS permits answering-machine messages but advises keeping them to little more than the practice’s name, its number and a request to call back.⁠³
FCC rules require consent before an autodialed or prerecorded call or text to a wireless number; the health care exemption covers only listed purposes such as appointment reminders.⁠^4,5
Practices must accept calls placed through a relay service, and staff must treat them like any other call.⁠⁶
On a paid DrSensory listing, a family’s message is read in the clinic’s portal and the clinic’s inquiry address gets only a notice, so that address needs an owner.
Measure the time to a first human reply and the time to an offered next step separately, and set targets from your own records rather than a borrowed benchmark.

Most of the standard is the practice’s own choice, set from its staffing rather than copied from another clinic, and the law shapes how a practice replies more than how fast. The exception is cost: a self-pay person’s question about cost counts as a request for a good faith estimate, due within 3 business days.⁠¹

What is a reply standard for therapy practice inquiries?

It is a short written rule, one line per channel, saying when the channel is watched, how soon a person replies, who replies, what the reply contains and when the question goes to someone else. Written down, “we try to call back quickly” becomes something a backup can follow and an owner can measure.

It keeps three kinds of reply apart, because a practice can meet one and miss another:

Automatic receipt. A form confirmation, an out-of-office email or a voicemail greeting. It tells the person what happens next; it is not a reply.
First human reply. A person from the practice answers by the route the inquirer used or chose.
Next step offered. The inquirer has an answer on fit or a concrete action: an intake call time, a form, a waitlist explanation or a suggestion to look elsewhere.

It covers people who are not yet patients: parents asking about a child, adults asking for themselves, and family or helpers asking for an adult. The intake call script covers the first call itself; this guide covers reaching it on time.

Which decisions does a reply standard need to settle?

Eight, each recorded where the backup can find it:

Decision	What to settle	Recorded as
Channels	Which routes the practice publishes, and which it closes because nobody watches them	A channel list matching the website, the greeting and every listing
Clock and targets	When the clock starts, which hours count, what stops it, and how soon each channel is answered	Written definitions and a target column
Ownership	A primary owner and a backup for each channel on each day	A coverage calendar
Content	What a first reply contains and leaves out	A few approved templates
Clinical questions	Which messages go to a clinician, and of which discipline	The clinicians’ escalation list
Privacy and consent	Email and text permissions, voicemail limits, who may hear what	A communication-preference field
Access and cost	Relay calls, written alternatives, interpreters; who issues good faith estimates	An access line and an estimate log
Review	Which measures are read each week, and by whom	The weekly worksheet

Fill in targets last: a target nobody can staff is a promise broken in the first busy week.

Which inquiry channels should a therapy practice answer?

Only the ones someone watches. Every published route needs a named owner and set check times; a route nobody checks comes off the website, the greeting and every listing.

Channel	When it is seen	What the standard has to say
Live phone	As calls ring in office hours	Who answers, what happens when lines are busy, and that relay calls are answered like any other call⁠⁶
Voicemail	At set check times	Who calls back, and what a callback message may say⁠³
Website form	At set check times	Which inbox it reaches, and what the confirmation promises
Email	At set check times	That replies go from a practice address, and how preferences are recorded⁠²
Text	At set check times, if the practice texts at all	Consent before texting, and how a STOP reply is honored⁠⁵
DrSensory inquiry	When the notice email is read	Who reads the message in the portal, and who replies

Social media inboxes follow the same rule: watch them or close them. The accessible inquiry forms guide covers what a form asks; its confirmation should promise no more than the standard meets.

How do family inquiries from DrSensory reach the clinic?

Through the clinic’s portal, with a notice by email. On a paid listing, a family writes with the Contact this provider button on the profile. The address the clinic gave as its email for family inquiries receives word that a message is waiting; the family’s words stay in the portal, where the clinic reads them, and the clinic answers from its own email address. Messages written to a listing nobody has claimed reach the DrSensory team first, and the team forwards them. DrSensory does not sell leads, and a family’s message is never passed to a different clinic (DrSensory for therapists).

Four lines of the standard follow:

The notice address. It does not appear on the profile, so make it a shared practice inbox someone checks, not a personal one (claim guide).
The clock. Start it when the notice arrives, the first moment the practice could know.
The reader. Each account comes with a login for every location plus one, and any of them can open inquiries (claim guide), so give the backup their own.
The reply. It goes from the practice’s email, so the email safeguards below apply.

When does the reply clock start, and what stops it?

The clock starts at the time the channel records and stops at the first human reply, counted in the business hours the practice publishes. Use each channel’s own timestamp: the call log, the voicemail time, the form submission, the email’s arrival or the DrSensory notice.

Clock definitions:

Business hours: [days and hours, time zone], closed on [holidays].
Received: the channel’s timestamp; anything outside business hours counts from [the next opening time].
First human reply: a person answers by the route the inquirer used or chose; an automatic receipt does not count.
Next step offered: an answer on fit, or a specific action with a time.
Closed: scheduled, waitlisted, pointed elsewhere, declined, or no response after [the number of] attempts over [the number of] business days.
Missed call with no message: [returned or not], logged as [how].

A callback that reaches voicemail is an attempt, not a reply; the clock runs until the person is reached, by phone or by the route they asked for, or the closing rule applies.

How do you choose a reply target the practice can keep?

Take it from your own records, not from a figure another practice quotes. Pull four to eight weeks of timestamps from the phone system, the shared inbox, the form and the portal notices, find each channel’s typical and slowest time to a first human reply, and set the target at what the practice met in its busiest week and in a week someone was out.

Publish a promise looser than the internal target: a team aiming to reply the same business day can promise the next business day and keep it in a bad week. A solo clinician who checks messages at lunch and at the end of the day sets the target at the next check.

Who should own inquiries, and who covers when they are out?

One named person per channel per day, with a named backup, on a calendar the whole team can see. “The front desk” is not an owner; a person is.

Shared addresses. Route the form, the published email and the DrSensory notice to a practice inbox, so a backup sees the same messages without forwarding.
Clinical routing by discipline. A clinical question goes to a clinician of the discipline asked about: a speech question to an SLP, not to the PT on duty.
Out-of-office replies. One that names when a person replies and what to do in an emergency helps; one that promises a call “shortly” does not.
Handover notes. Each open inquiry carries its status, last contact and next action, as the waitlist guide does for waiting families.
Outside services. Before an answering service takes messages for a covered practice, check whether it acts as a business associate; HHS requires a written contract whenever a covered entity engages one to help with its health care activities.⁠⁷

If no one covers a solo clinician’s leave, change the greeting, the form confirmation and the listing’s availability first, and say when replies resume.

What should the first reply to a therapy inquiry say?

Who is replying, the one next step and how to take it, what is not yet decided, when the next contact comes, that a cost estimate is available to anyone paying for themselves, and where not to send sensitive details. Match the detail the inquirer used, never repeat their health details back, and say that fit, coverage and the appointment are not yet settled, so the reply does not read as acceptance.

The new patient email templates hold the follow-ups: scheduling options, payment questions, a missing step, a service you do not offer and the waitlist.

What should a first reply say about referrals and orders?

That the answer turns on discipline, state and coverage, which the practice checks before the evaluation; never a blanket “no referral needed.” For physical therapy, every state has some form of direct access, provisional or unrestricted, according to APTA’s count as of July 1, 2025, though a number of states keep conditions on treating without a referral.⁠⁸ Medicare adds a step for all three disciplines: when a PT, OT or SLP establishes the plan of treatment, a physician, nurse practitioner, clinical nurse specialist or physician assistant who knows the case signs the certification, unless a written order or referral is in the record and the plan reached that practitioner within 30 days of the initial evaluation; recertification is due at least every 90 days, and the rule states that it does not itself require an order or referral.⁠⁹ For OT and SLP, check your state practice act, and for any discipline the person’s plan, before answering; the insurance and fees guide has the payment wording.

What should a reply say to a self-pay inquirer asking about cost?

That a good faith estimate is available, and when it arrives. The No Surprises Act rule applies to any health care provider acting within the scope of a state license or certification, which reaches licensed OTs, PTs and SLPs. It requires asking whether a person has coverage they mean to use, telling uninsured and self-pay people, including those with coverage who do not want a claim submitted, that an estimate is available, and treating any discussion or inquiry about potential costs as a request for one.⁠¹

A request starts a 3-business-day deadline. Booking sets its own: one business day from scheduling for a visit at least 3 business days out, and three business days for a visit at least 10 out.⁠¹ So cost questions get their own owner and their own clock, logged from the date of the question. What the estimate contains is set out in why callers do not book.

How do HIPAA rules shape email, text and voicemail replies?

For a covered practice, HIPAA allows replies by email, phone and voicemail and shapes what they say: reasonable safeguards, little detail where others may see or hear it, and another route when a person reasonably asks.⁠^2,3 A provider is covered only when it sends information electronically as part of one of the transactions HHS has standardized.⁠⁷

What an inquirer writes about a condition is health information once a provider receives it: the HIPAA definition covers information, oral or recorded, that a provider receives and that relates to a person’s physical or mental health or condition.⁠¹⁰

Email. HHS permits email between covered providers and patients when reasonable safeguards are in place, such as checking the address and limiting the information an unencrypted message carries. When a patient writes first, the provider may assume email is acceptable unless told otherwise, and may explain the risks of unencrypted email and let the patient decide.⁠² The Security Rule does not prohibit email, but a covered practice must assess how it protects information in transit, choose a solution and document the decision.⁠¹¹
Voicemail. HHS permits answering-machine messages and suggests limiting what they disclose, such as leaving only a name and number or asking for a call back; a message may also be left with a family member who answers.⁠³
Another route on request. A reasonable request to be reached another way must be accommodated; if unencrypted email is unacceptable to the person, offer a more secure method, mail or the phone.⁠^2,3
Texts. HHS’s email answer speaks of communicating electronically, such as through email, so give texts the same safeguards: the practice’s name, no health details, a number to call.⁠²

The voicemail limit comes from the duty to safeguard, not from the minimum necessary standard, which HHS says does not apply to disclosures to the person the information is about; the care is for whoever else might hear it.⁠¹²

Who may the practice speak with about a child or an adult?

For a child, usually the parent; for an adult, the adult, and family members with the adult’s agreement. HHS treats a parent, guardian or person acting in loco parentis as a minor’s personal representative in most cases, deferring to state law on what a parent may obtain.⁠¹³ When an adult patient is present and able to decide, a provider may discuss their health information with a family member if the patient agrees or does not object, sharing only what that person needs to know.⁠¹⁴ HIPAA does not require proof of identity from a caller who says they are family, though a practice may set its own verification rules.⁠¹⁵

So a first reply to a daughter asking about therapy for her father explains the services and process, which is not his health information, and asks how he would like to be involved; his condition waits until he agrees.

What does the TCPA require before a practice texts an inquirer?

Consent, before the first automated text. Under the Telephone Consumer Protection Act, the FCC requires oral or written consent before an autodialed or prerecorded call or text to a wireless number and written consent for commercial texts, and lets a person opt out at any time in any reasonable manner.⁠⁴ Its rule text treats a text message as a call.⁠⁵

The health care exemption is narrow, covering providers’ calls and texts only when every condition holds: the patient provided the number; the message costs the recipient nothing and names the provider and its contact information; its purpose is on a closed list that includes appointment and exam confirmations and reminders, wellness checkups and home healthcare instructions; it carries no telemarketing, advertising, billing or other financial content and complies with HIPAA; a text runs 160 characters or less; no more than one message a day and three a week go to each patient; each text says the person can reply STOP; and opt-outs are honored immediately.⁠⁵ A reply to an inquiry, a marketing text and a balance reminder all sit outside that list.

Revoking consent is broad. Any reasonable method counts, replies such as stop, quit, end, revoke, opt out, cancel or unsubscribe count automatically, and a revocation must be honored within a reasonable time of no more than ten business days.⁠⁵ One confirmation text is allowed if it only confirms and carries no marketing, and one sent within five minutes is presumed covered by the earlier consent.⁠⁵

So the standard says: text only a number the person gave for texts, after they agree to the kinds of text you send; keep that consent apart from any marketing consent; name the practice and the way to stop in every text; and honor every opt-out at once. Whether a texting system counts as an autodialer is a question for counsel; consent first avoids depending on the answer.

Does CAN-SPAM apply to a practice’s replies to inquiries?

It applies to email whose primary purpose is to advertise or promote, so a reply that sticks to the person’s question stays clear of it. The FTC explains that the law covers commercial messages, defined by that primary purpose; a message with only transactional or relationship content must not carry misleading routing information but is otherwise exempt from most of the law, a category the FTC reads narrowly.⁠¹⁶ A subject line a reader would reasonably take as an advertisement makes a mixed message commercial.⁠¹⁶

Keep the first reply to services, fit, the next step and the cost process, with no promotion in the subject line or at the top. Send a newsletter only to people who asked for it, with the FTC’s commercial-email elements: accurate header information, an honest subject line, identification as an advertisement, a valid physical postal address and an opt-out honored within 10 business days.⁠¹⁶

How do relay calls and access needs change a reply standard?

Answer relay calls like any other call, and offer a reply route that matches how the person communicates. The Americans with Disabilities Act requires businesses that serve the public to communicate effectively with people who have communication disabilities, including a patient’s parent, spouse or companion in appropriate circumstances, and to accept relay calls and treat them like other calls.⁠⁶ Relay gives people with hearing or speech disabilities a way to make and take phone calls, dialing 711 reaches several kinds of it, and speech-to-speech relay is built for people with speech disabilities; the FCC warns that relay calls are sometimes dropped by people who mistake the assistant for a telemarketer.⁠¹⁷ HHS does not require a business associate contract with a relay service, and when a person calls through relay the provider may infer they do not object to the assistant hearing the call.⁠¹⁸

For an SLP practice serving adults this is everyday work: an adult with aphasia may inquire by email, by text, through speech-to-speech relay or with a helper. ADA.gov notes that simply allowing more time with someone who uses a communication board or device may provide effective communication, and encourages consulting the person about which aid works.⁠⁶

So the standard trains staff to stay on a relay call, names a written route beside every callback, and says who arranges an interpreter or other aid. How intake handles a request for Spanish or another language is set out in the bilingual services guide.

Where should clinical concerns in an inquiry be routed?

To a clinician of the right discipline, through a written list the clinicians write, and never into the routine queue. Front-desk staff do not judge urgency; they recognize items on the list and pass them on.

An emergency. The greeting, form confirmation and out-of-office reply say the inbox is not watched for emergencies and the person should call 911.
A time-sensitive clinical question. The list names what goes to a clinician the same business day, and who covers each discipline.
A question only a clinician can answer. Whether a service fits, what an evaluation involves, whether therapy can wait: the reply says a clinician answers, and when.

Each discipline writes its own entries; an SLP practice taking feeding and swallowing inquiries, for example, decides which descriptions go straight to a clinician (see the feeding and swallowing guide). Escalations get their own line in the weekly review.

What does a written reply standard look like for each channel?

One row per channel, with the columns a backup needs. Fill the brackets from the practice’s own staffing; the one deadline in it set by law is the good faith estimate’s.⁠¹

Channel	Watched	First human reply	Owner and backup	Escalate when
Phone	[days and hours]	Live; busy-line calls returned by [target]	[owner]; [backup]	The caller describes an item on the clinicians’ list
Voicemail	Checked at [times]	Callback by [target]	[owner]; [backup]	As for the phone
Website form	Checked at [times]	By [target], by the route chosen on the form	[owner]; [backup]	The message asks a clinical question
Email	Checked at [times]	By [target], from a practice address	[owner]; [backup]	A clinical question, or records attached
Text	Checked at [times], consented numbers only	By [target]	[owner]; [backup]	Anything clinical moves to a call
DrSensory inquiry	Notice inbox and portal at [times]	By [target], from the practice’s email	[owner]; [backup], each with a login	As for email
Self-pay cost question	Logged the day it is asked	Estimate no later than 3 business days after the request⁠¹	[billing owner]; [backup]	The service or visit count is unclear

Reply standard for [practice], version of [the date]:

Business hours and holidays: [hours, time zone, closures]
Published promise: [the words the greeting, form and website use]
Targets and templates: [by channel]
Coverage calendar and escalation list: [where each is kept; the clinician who owns each discipline’s list]
Access: [who arranges interpreters and other aids]
Reviewed weekly by: [your name and role], every [day of the week]

Which reply templates does an intake team need first?

Three the email templates guide does not cover: a voicemail callback, a first reply to a message the person wrote, and a text opt-in confirmation. Replace every bracket and keep health details out of all three.

What should a voicemail callback message say?

Only enough for a call back: the practice, your first name, the number and the hours. HHS suggests leaving only the name and number and asking the person to call back.⁠³ Leave out the child’s name, the service and any condition.

Voicemail callback:

“Hello, this is [your first name] at [practice], returning a call to this number. You can reach us at [number] between [hours] on [days]. If email or text suits you better, tell us when we speak and we can use that instead. Thank you.”

Last attempt, under the closing rule:

“Hello, this is [your first name] at [practice], calling back once more. Call [number] between [hours] on [days], or write to [email address], whenever it suits you. If you no longer need us, there is nothing you need to do.”

What should a first email reply to a new inquiry say?

The first-reply elements, at the level of detail the person used. It suits a website form, a direct email or a family’s DrSensory message read in the portal, and it answers what they wrote.

Subject: Your message to [practice]

Hello [their preferred name],

Thank you for writing to [practice]. I am [your name], [your role], and I read your message today.

[One or two sentences answering their question at the level they asked, without repeating health details; for example, that the practice sees [age group] for [discipline] at its [setting] clinic.]

The next step is [an intake call, a short form, or a call with our clinician]. [How to take it: times to choose from, a secure form link, or a number to call.] We have not yet confirmed fit, coverage or an appointment; we work those out together at that step.

[If they may pay for themselves:] If you plan to pay for yourself rather than use insurance, you can ask us for a good faith estimate of the expected charges.

Email is convenient but not encrypted. If you would rather we call, or you have records to share, please use [secure route or phone number].

Thank you,

[your name], [practice], [phone number]

What should a text opt-in confirmation message say?

Who is texting, what the texts are for, how often, and how to stop, sent right after the person agrees. Keep every text within 160 characters, the limit for texts under the health care exemption, and record the agreement.⁠⁵

Opt-in confirmation:

[Practice]: You agreed to texts about intake steps and appointment times at this number, up to [number] a week. No health details by text. Reply STOP to end.

Reply to a STOP, sent once, within five minutes:

[Practice]: You are unsubscribed and get no more texts from us. To reach us, call [number].

Consent record:

Who agreed, and for whom: [their name; the patient, if different]
Number and kinds of text: [the mobile number given; intake steps, appointment confirmations and reminders]
How and when: [said on a call, a form checkbox or a reply of YES; the day and time]
Marketing texts: [agreed separately in writing, or not agreed]

How should a practice measure whether it meets its standard?

Each week, count inquiries by channel against each channel’s target, then read the slow and unresolved ones in the record system. Speed alone is the wrong score: an instant reply that sets no next step meets a timer and fails the person.

Measure	How to count it	What it shows
Inquiries received	New inquiries by channel, counted once when a person used two routes	Where people reach you
Replied within target	Inquiries with a first human reply inside the channel’s target, out of those received	Whether coverage works
Time to first human reply	Typical and longest, in business hours	Whether the target is realistic
Next step offered	Inquiries with an answer on fit or a specific action, and the time to reach it	Whether replies move anything
Open with no next action	Inquiries still open at the week’s end with no named next step	What the handover missed
Closed, by reason	Scheduled, waitlisted, pointed elsewhere, not a fit, declined, no response	What happens after the reply
Estimates and escalations	Self-pay estimates issued by the deadline; time to a clinician’s contact	Whether the two urgent clocks hold⁠¹

The review sheet carries counts; names and health details stay in the record system. To judge what DrSensory or another directory produces, keep its inquiries on their own line and use the listing-value guide. Why people do not book after a timely reply is a separate question, covered in why callers do not book.

What goes on a weekly reply-standard review worksheet?

The week’s counts against each target, the misses with their reasons, and one change to try.

Weekly reply review, week of [the date]:

Reviewed by: [who read it, and when]
Coverage: [who owned each channel; who was out; who covered]
Inquiries by channel: phone [count], voicemail [count], form [count], email [count], text [count], DrSensory [count]
Replied within target: [count] of [count]; longest wait [business hours] on [channel], because [reason]
Open with no next action: [count], now assigned to [owner]
Self-pay estimates: [count] requested; [count] issued by the deadline
Clinical escalations: [count]; longest time to a clinician’s contact [hours]
Relay, aid and language requests: [count]; any not met [what happened]
Text opt-outs: [count], each honored on [the day]
Whether the published promise held: [yes, or the miss and its cause]
One change for next week: [the change, its owner, the day to check it]

How does a reply standard work when the coordinator is out?

Hypothetical. A clinic offering OT and speech therapy to children and adults has this standard: phones answered 8:00 a.m. to 5:00 p.m. on weekdays; voicemail, the shared inbox and the DrSensory portal checked at 9:00, 12:30 and 4:30; a first human reply by the end of the next business day, also its published promise. The intake coordinator is on leave; the calendar names the office manager as owner and the SLP as clinical backup.

Friday, 6:40 p.m. A DrSensory notice arrives: a parent asks whether the practice evaluates speech for a three-year-old and what an evaluation costs without insurance. The clock counts from Monday’s opening.

Saturday. A woman leaves a voicemail about therapy for her father, who had a stroke and needs help with dressing and speaking.

Monday, 9:00 a.m. The office manager reads the parent’s message in the portal under her own login, replies from the practice’s email with the first-reply template, and logs the cost question as an estimate request dated Friday. The billing owner issues the estimate on Tuesday, inside the deadline that ends Wednesday.⁠¹

Monday, 9:20 a.m. She calls the daughter and leaves the callback message, with no mention of a stroke or a service. At noon the daughter calls back and hears about both services; her father joins the call, agrees to her help, and asks for email because the phone is hard for him. The SLP emails him that afternoon to set a video call.

Friday review. Both inquiries met the target. One gap: the clinic’s email for family inquiries was still the coordinator’s personal address, and the message was found only because the backup checks the portal itself. The address changes to the shared inbox that day.

These hours and targets are this practice’s inputs, not recommendations or benchmarks.

What should a practice publish about its reply times?

Only the promise it met in its worst recent week, in the same words everywhere a person might look.

Voicemail greeting: the hours, when messages are returned, a written route for anyone who prefers one, and what to do in an emergency.
Form confirmation and auto-replies: what happens next and by when, saying “received” only when the message has reached the team.
Website and office: the same promise, plus the notice that self-pay patients can get a good faith estimate, which the rule requires on the website, in the office and where scheduling happens, in accessible formats and the languages inquirers speak.⁠¹
Listings: on DrSensory, keep “accepting new patients” and the typical wait current (claim guide); the directory profile guide covers other directories.

When the standard changes, change all of them the same day and note it in the version line.

Frequently asked questions

How quickly should a therapy practice reply to a new inquiry?

As quickly as its staffing allows in its busiest week, which only its own records show. Set an internal target per channel from several weeks of timestamps, publish a looser promise, and track one legal clock separately: a self-pay cost question requires a good faith estimate within 3 business days.⁠¹

Does an automatic reply count as answering an inquiry?

No. A form confirmation, an auto-reply or a voicemail greeting tells the person what happens next, but the reply clock runs until a person from the practice answers by the route the inquirer used or chose.

Can a therapy practice reply to an inquiry by ordinary email?

Yes, with reasonable safeguards. HHS allows covered providers to email patients, lets a provider assume email is acceptable when the patient wrote first, and suggests explaining the risks of unencrypted email and letting the patient decide.⁠²

What can staff say in a voicemail to someone who inquired?

The practice name, a first name, the number and the hours, with a request to call back. HHS permits answering-machine messages and advises limiting what they say, so leave out the service, the condition and a child’s name.⁠³

Do we need consent to text someone who inquired?

Before any autodialed or prerecorded text, yes: the FCC requires consent for those texts to a wireless number, and written consent for commercial texts.⁠⁴ The health care exemption covers listed purposes such as appointment reminders, a list that does not include replies to inquiries.⁠⁵

Can we add people who inquire to our email newsletter?

Ask them separately rather than adding them automatically. Promotional email must meet CAN-SPAM’s requirements, including a valid physical postal address and an opt-out honored within 10 business days.⁠¹⁶

Must a practice answer calls that come through a relay service?

Yes. ADA.gov states that businesses serving the public must accept calls placed through relay services and that staff must treat them like other calls.⁠⁶

Who reads DrSensory inquiries sent to an unclaimed listing?

The DrSensory team, which forwards it. Once a clinic has a paid listing, its own team reads families’ messages in the portal (DrSensory for therapists).

Should clinicians answer new inquiries themselves?

They answer the clinical questions, and anyone trained can answer the rest; in a group practice, each clinical question goes to a clinician of the discipline asked about.

Can a reply tell a family that no referral is needed?

Not as a blanket rule. Every state allows some direct access to physical therapy but some attach conditions, and Medicare requires a certified plan of treatment for PT, OT and SLP, signed by a physician or nonphysician practitioner unless an order or referral is on file and the plan reached them within 30 days of the evaluation.⁠^8,9

Sources

eCFR. 45 CFR 149.610, Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals (No Surprises Act rule; up to date as of October 22, 2026). Checked October 23, 2026.
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“Health care provider (provider) means a physician or other health care provider who is acting within the scope of practice of that provider’s license or certification under applicable State law”; “but who does not seek to have a claim for such item or service submitted to such plan or coverage”; “Informing all uninsured (or self-pay) individuals of the availability of a good faith estimate of expected charges upon scheduling an item or service or upon request”; “prominently displayed (and easily searchable from a public search engine) on the convening provider’s or convening facility’s website, in the office, and on-site where scheduling or questions about the cost of items or services occur”; “Orally provided when scheduling an item or service or when questions about the cost of items or services occur”; “Made available in accessible formats, and in the language(s) spoken by individual(s) considering or scheduling items or services”; “Convening providers and convening facilities shall consider any discussion or inquiry regarding the potential costs of items or services under consideration as a request for a good faith estimate”; “When a primary item or service is scheduled at least 3 business days before the date the item or service is scheduled to be furnished: Not later than 1 business day after the date of scheduling”; “When a primary item or service is scheduled at least 10 business days before such item or service is scheduled to be furnished: Not later than 3 business days after the date of scheduling”; “When a good faith estimate is requested by an uninsured (or self-pay) individual: Not later than 3 business days after the date of the request.”.
U.S. Department of Health and Human Services, Office for Civil Rights. Does the HIPAA Privacy Rule permit health care providers to use e-mail to discuss health issues and treatment with their patients? (HIPAA FAQ; content last reviewed July 26, 2013). Checked October 23, 2026.
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“Yes. The Privacy Rule allows covered health care providers to communicate electronically, such as through e-mail, with their patients, provided they apply reasonable safeguards when doing so.”; “checking the e-mail address for accuracy before sending”; “other safeguards should be applied to reasonably protect privacy, such as limiting the amount or type of information disclosed through the unencrypted e-mail”; “if the use of unencrypted e-mail is unacceptable to a patient who requests confidential communications, other means of communicating with the patient, such as by more secure electronic methods, or by mail or telephone, should be offered and accommodated.”; “Patients may initiate communications with a provider using e-mail. If this situation occurs, the health care provider can assume (unless the patient has explicitly stated otherwise) that e-mail communications are acceptable to the individual.”; “the provider can alert the patient of those risks, and let the patient decide whether to continue e-mail communications.”.
U.S. Department of Health and Human Services, Office for Civil Rights. May physician’s offices or pharmacists leave messages for patients at their homes, either on an answering machine or with a family member? (HIPAA FAQ; content last reviewed December 28, 2022). Checked October 23, 2026.
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“the Rule does not prohibit covered entities from leaving messages for patients on their answering machines. However, to reasonably safeguard the individual’s privacy, covered entities should take care to limit the amount of information disclosed on the answering machine. For example, a covered entity might want to consider leaving only its name and number and other information necessary to confirm an appointment, or ask the individual to call back.”; “A covered entity also may leave a message with a family member or other person who answers the phone when the patient is not home.”; “In situations where a patient has requested that the covered entity communicate with him in a confidential manner, such as by alternative means or at an alternative location, the covered entity must accommodate that request, if reasonable.”.
Federal Communications Commission. Stop Unwanted Robocalls and Texts (consumer guide; last updated or reviewed February 27, 2026). Checked October 23, 2026.
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“FCC rules require a caller to obtain your prior written consent – on paper or through electronic means, including website forms or a telephone keypress – before they make a prerecorded telemarketing call to your home or wireless phone number. FCC rules also require a caller to obtain your oral or written consent before making an autodialed or prerecorded call or text to your wireless number.”; “You may opt out of any robocall or robotext at any time and in any reasonable manner, even if you previously gave consent for such calls.”; “All prerecorded voice message calls must include the caller’s name, number, and business name at the beginning of the message.”; “Commercial texts require written consent; for informational texts, your consent may be oral.”.
eCFR. 47 CFR 64.1200, Delivery restrictions (the FCC’s Telephone Consumer Protection Act rules; up to date as of October 22, 2026). Checked October 23, 2026.
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“initiate any telephone call (other than a call made for emergency purposes or is made with the prior express consent of the called party) using an automatic telephone dialing system or an artificial or prerecorded voice”; “To any telephone number assigned to a paging service, cellular telephone service”; “provided that the call is not charged to the called person or counted against the called person’s plan limits on minutes or texts. As used in this paragraph (a)(9), the term ‘call’ includes a text message, including a short message service (SMS) call.”; “Calls made by, or on behalf of, healthcare providers”; “Voice calls and text messages must be sent only to the wireless telephone number provided by the patient”; “Voice calls and text messages must state the name and contact information of the healthcare provider”; “Voice calls and text messages are strictly limited to those for the following purposes: appointment and exam confirmations and reminders, wellness checkups, hospital pre-registration instructions, pre-operative instructions, lab results, post-discharge follow-up intended to prevent readmission, prescription notifications, and home healthcare instructions”; “must not include any telemarketing, solicitation, or advertising; may not include accounting, billing, debt-collection, or other financial content; and must comply with HIPAA privacy rules”; “160 characters or less in length for text messages”; “A healthcare provider may initiate only one message (whether by voice call or text message) per day to each patient, up to a maximum of three voice calls or text messages combined per week to each patient”; “text messages must inform recipients of the ability to opt out by replying ‘STOP,’”; “A healthcare provider must honor opt-out requests immediately.”; “A called party may revoke prior express consent, including prior express written consent, to receive calls or text messages made pursuant to paragraphs (a)(1) through (3) and (c)(2) of this section by using any reasonable method to clearly express a desire not to receive further calls or text messages from the caller or sender.”; “using the words ‘stop,’ ‘quit,’ ‘end,’ ‘revoke,’ ‘opt out,’ ‘cancel,’ or ‘unsubscribe’ sent in reply to an incoming text message”; “must be honored within a reasonable time not to exceed ten business days from receipt of such request”; “A one-time text message confirming a request to revoke consent from receiving any further calls or text messages does not violate paragraphs (a)(1) and (2) of this section as long as the confirmation text merely confirms the text recipient’s revocation request and does not include any marketing or promotional information”; “If the confirmation text is sent within five minutes of receipt, it will be presumed to fall within the consumer’s prior express consent.”.
U.S. Department of Justice, Civil Rights Division, ADA.gov. ADA Requirements: Effective Communication (guidance; last updated February 28, 2020). Checked October 23, 2026.
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“The ADA requires that title II entities (State and local governments) and title III entities (businesses and nonprofit organizations that serve the public) communicate effectively with people who have communication disabilities.”; “The key to communicating effectively is to consider the nature, length, complexity, and context of the communication and the person’s normal method(s) of communication.”; “The rules apply to communicating with the person who is receiving the covered entity’s goods or services as well as with that person’s parent, spouse, or companion in appropriate circumstances.”; “simply allowing more time to communicate with someone who uses a communication board or device may provide effective communication”; “Covered entities are also required to accept telephone calls placed through TRS and VRS, and staff who answer the telephone must treat relay calls just like other calls.”; “Title III entities are encouraged to consult with the person with a disability to discuss what aid or service is appropriate.”.
U.S. Department of Health and Human Services. Covered Entities and Business Associates (content last reviewed August 21, 2024). Checked October 23, 2026.
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“If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate”; “If an entity does not meet the definition of a covered entity or business associate, it does not have to comply with the HIPAA Rules.”; “but only if they transmit any information in an electronic form in connection with a transaction for which HHS has adopted a standard.”.
American Physical Therapy Association. Direct Access Advocacy (advocacy issue page). Checked October 23, 2026.
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“As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment. Even though patients may go directly to a physical therapist without a referral, some provisions tied to treatment absent a referral still persist in a number of states”.
eCFR. 42 CFR 424.24, Requirements for medical and other health services furnished by providers under Medicare Part B (paragraphs (c)(3), (c)(4) and (c)(5), outpatient physical therapy, occupational therapy and speech-language pathology services; up to date as of October 22, 2026). Checked October 23, 2026.
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“If the plan of treatment is established by a physical therapist, occupational therapist, or speech-language pathologist, the certification must be signed by a physician or by a nurse practitioner, clinical nurse specialist, or physician assistant who has knowledge of the case”; “Recertification is required at least every 90 days.”; “If the plan of treatment is established by a physical therapist, occupational therapist, or speech-language pathologist, and there is a written order or referral from the individual’s physician, nurse practitioner (NP), physician assistant (PA), or clinical nurse specialist (CNS) in the patient’s record and the therapist has documented evidence that the plan of treatment has been delivered to the physician, NP, PA, or CNS within 30 days of completion of the initial evaluation, the certification does not need to be signed by a physician, NP, CNS, or PA who has knowledge of the case.”; “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.”.
eCFR. 45 CFR 160.103, Definitions (HIPAA Administrative Simplification; up to date as of October 22, 2026). Checked October 23, 2026.
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“Health information means any information, including genetic information, whether oral or recorded in any form or medium, that: (1) Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and (2) Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual.”.
U.S. Department of Health and Human Services, Office for Civil Rights. Does the Security Rule allow for sending electronic PHI (e-PHI) in an email or over the Internet? If so, what protections must be applied? (HIPAA FAQ; content last reviewed July 26, 2013). Checked October 23, 2026.
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“The Security Rule does not expressly prohibit the use of email for sending e-PHI.”; “the covered entity must assess its use of open networks, identify the available and appropriate means to protect e-PHI as it is transmitted, select a solution, and document the decision.”.
U.S. Department of Health and Human Services, Office for Civil Rights. Minimum Necessary Requirement (Privacy Rule guidance, 45 CFR 164.502(b) and 164.514(d); content last reviewed July 26, 2013). Checked October 23, 2026.
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“The Privacy Rule generally requires covered entities to take reasonable steps to limit the use or disclosure of, and requests for, protected health information to the minimum necessary to accomplish the intended purpose.”; “The minimum necessary standard does not apply to the following:”; “Disclosures to the individual who is the subject of the information.”.
U.S. Department of Health and Human Services, Office for Civil Rights. Personal Representatives (Privacy Rule guidance; content last reviewed January 5, 2024). Checked October 23, 2026.
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“In most cases under the Rule, a parent, guardian, or other person acting in loco parentis (collectively, “parent”) is the personal representative of the minor child and can exercise the minor’s rights with respect to protected health information, because the parent usually has the authority to make health care decisions about his or her minor child.”; “the Privacy Rule defers to State or other applicable laws that expressly address the ability of the parent to obtain health information about the minor child.”.
U.S. Department of Health and Human Services, Office for Civil Rights. If the patient is present and has the capacity to make health care decisions, when does HIPAA allow a health care provider to discuss the patient’s health information with the patient’s family, friends, or others involved in the patient’s care or payment for care? (HIPAA FAQ; content last reviewed July 26, 2013). Checked October 23, 2026.
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“a health care provider may discuss the patient’s health information with a family member, friend, or other person if the patient agrees or, when given the opportunity, does not object.”; “the health care provider may share or discuss only the information that the person involved needs to know about the patient’s care or payment for care.”.
U.S. Department of Health and Human Services, Office for Civil Rights. If a patient’s family member, friend, or other person involved in the patient’s care or payment for care calls a health care provider to ask about the patient’s condition, does HIPAA require the health care provider to obtain proof of who the person is before speaking with them? (HIPAA FAQ; content last reviewed July 26, 2013). Checked October 23, 2026.
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“If the caller states that he or she is a family member or friend of the patient, or is involved in the patient’s care or payment for care, then HIPAA doesn’t require proof of identity in this case. However, a health care provider may establish his or her own rules for verifying who is on the phone.”.
Federal Trade Commission. CAN-SPAM Act: A Compliance Guide for Business (business guidance, August 2023, edited January 2024). Checked October 23, 2026.
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“It covers all commercial messages, which the law defines as ‘any electronic mail message the primary purpose of which is the commercial advertisement or promotion of a commercial product or service,’”; “Don’t use false or misleading header information.”; “Don’t use deceptive subject lines.”; “Identify the message as an ad.”; “What matters is the ‘primary purpose’ of the message.”; “Transactional or relationship content – which facilitates an already agreed-upon transaction or updates a customer about an ongoing transaction”; “If it contains only transactional or relationship content, its primary purpose is transactional or relationship. In that case, it may not contain false or misleading routing information, but is otherwise exempt from most provisions of the CAN-SPAM Act.”; “Keep in mind that the law views these categories narrowly.”; “A recipient reasonably interpreting the subject line would likely conclude that the message advertises or promotes a commercial product or service”; “Your message must include your valid physical postal address.”; “You must honor a recipient’s opt-out request within 10 business days.”.
Federal Communications Commission. Telecommunications Relay Service – TRS (consumer guide; last updated or reviewed August 16, 2022). Checked October 23, 2026.
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“Telecommunications Relay Service allows persons with hearing or speech disabilities to place and receive telephone calls.”; “Speech-to-Speech Relay Service is used by a person with a speech disability.”; “you can dial 711 to connect to certain forms of TRS anywhere in the United States”; “Some people hang up on TRS calls because they think the CA is a telemarketer.”; “TRS providers must ensure user confidentiality and CAs (with a limited exception for STS) may not keep records of the contents of any conversation”.
U.S. Department of Health and Human Services, Office for Civil Rights. When a covered entity, such as a doctor, uses a certified Telecommunications Relay Service to contact patients with hearing or speech impairments, is the Relay Service a business associate of the doctor? (HIPAA FAQ; content last reviewed January 9, 2023). Checked October 23, 2026.
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“a covered entity such as a doctor can contact a patient using a Telecommunications Relay Service (TRS), without the need for a business associate contract with the TRS.”; “Where the individual initiates the call through the TRS, it is reasonable for a covered health care provider to infer from these circumstances that the individual has identified the CA as involved in the individual’s care, and that the individual does not object to the disclosure.”.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy practice, not legal, compliance, billing or financial advice. HIPAA, texting, email and No Surprises Act duties depend on the practice’s facts and state law, and its examples are hypothetical, not DrSensory data or benchmarks.

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