Keeping SMS running without thinking about it
The SMS Settings page is a single scrolling page — there are no tabs — covering everything related to your clinic's SMS credit: your current balance, where incoming SMS replies get forwarded, and two independent safety nets that keep you from running dry unexpectedly: auto top-up and a low-balance reminder.
SMS quietly underpins a lot of day-to-day clinic operations — appointment confirmations, reminders, cancellation notices, and anything you send through Broadcasts or a manual template all draw from the same credit balance. Because those messages usually fire automatically in the background, an empty balance doesn't announce itself the way a failed manual action would — it just quietly stops confirmations from going out until someone notices. This page is where you make sure that doesn't happen unnoticed.
- Where to check your SMS credit balance and why it's separate from your subscription
- How reply forwarding routes patient replies to the right place
- How auto top-up works, including the conditional fields that dim when it's off
- How the low-balance reminder works as an alternative or companion to auto top-up
- How to pick sensible thresholds instead of guessing
A prepaid balance, separate from your subscription
Checking your balance
The balance card at the top of the page shows how much SMS credit your clinic currently has available. Keep an eye on it: running out of credit stops all outgoing SMS, including automated appointment confirmations, reminders, and cancellation notices, until you top up. Because those messages send silently in the background, a clinic that isn't watching this number can go days without realizing patients have stopped receiving reminders.
Reply forwarding
When a patient replies to an SMS from your clinic — confirming an appointment, asking a question, or replying to a broadcast — reply forwarding controls where that reply actually goes. Configure this deliberately rather than leaving it on a default: an unanswered patient reply reads to them as a clinic that doesn't listen, even if the original outbound message worked perfectly.
Point replies at whichever staff member or shared inbox is actually responsible for triaging incoming patient messages day to day. If that responsibility changes — a staff change, a new front-desk process — update this setting at the same time, since a forgotten forwarding rule is a quiet way for replies to start going to someone who's no longer checking them.
Auto top-up
Auto top-up automatically purchases more SMS credit as soon as your balance drops below a threshold you set, so you never have to top up manually or risk running out mid-week because nobody was watching the balance card.
Turn on Auto top-up
Switch the <strong>Auto top-up</strong> toggle on. Its threshold and amount fields become active.
Set the threshold
Enter a value in <strong>Top up when balance below</strong> — the balance that triggers a top-up.
Set the top-up amount
Enter a value in <strong>Amount to top up</strong> — how much credit to purchase each time the threshold is hit.
Save your changes
Click <strong>Save</strong> to apply the settings.
Low-balance reminder
If you'd rather approve every top-up yourself instead of letting a card be charged automatically, the low-balance reminder notifies you when your SMS credit is running low, without buying more credit on its own.
Turn on Low-balance reminder
Switch the <strong>Low-balance reminder</strong> toggle on. Its threshold field becomes active.
Set the threshold
Enter a value in <strong>Remind me when below</strong> — the balance that triggers a reminder.
Save your changes
Click <strong>Save</strong> to apply the settings.
Getting the thresholds right
Both toggles are only as useful as the threshold behind them. Set a threshold too low, and it fires the moment you're already almost out — leaving no real buffer before automated messages start failing. Set it too high, and auto top-up ends up charging your card far more often than necessary, or the low-balance reminder becomes background noise you start ignoring.
The most reliable way to choose a sensible number is to look at your own usage rather than guess. Check the SMS Usage & Balance Report for a typical week or month, and set your threshold high enough to cover several days of normal sending — enough of a buffer that a slightly busier-than-usual week, or a delay in noticing a reminder, doesn't push you all the way to zero before you can react.
| Clinic pattern | Suggested approach |
|---|---|
| Steady, predictable SMS volume week to week | A moderate threshold covering roughly a week of typical usage, with auto top-up on, keeps this mostly hands-off. |
| Volume that spikes around campaigns or seasonal promotions | Set the threshold higher than your quiet-week usage would suggest, sized to your busiest recent send rather than your average. |
| Clinics that want manual control over every charge to their card | Leave auto top-up off and rely on the low-balance reminder, sized with enough runway to log in and top up manually before hitting zero. |
| New clinics without an established usage pattern yet | Start with the low-balance reminder alone for the first month, then set an informed auto top-up threshold once the <a href="/reports-communications/sms-usage-and-balance/">usage report</a> shows a real pattern. |