> ## Documentation Index
> Fetch the complete documentation index at: https://docs.byblend.com/llms.txt
> Use this file to discover all available pages before exploring further.

# How does patient messaging work in Blend?

> When a patient replies to a Blend text message, it lands in your Messaging inbox in the Blend Dashboard, with an unread badge and optional webhook or email alerts. You reply within a thread; your team marks your own conversations as read.

When a patient replies to a Blend text message (either a shipping confirmation or a refill reminder), it lands in your **Messaging** inbox in the Blend Dashboard — not in a shared queue, and not with Blend staff. Blend matches the inbound message to the patient and routes it to the business that owns them.

You'll see two inboxes: **Patients** for active conversations, and **Archive** for ones you've closed out. An unread badge appears in the sidebar and on the Dashboard home page.

## Getting notified

Beyond the in-app badge, you can be alerted by **webhook** or **email** when a patient message arrives — useful if your team doesn't live in the Blend Dashboard all day. Set these up alongside your other notification subscriptions; see [webhooks](/guides/webhooks).

## Replying

<Note>
  Patient messaging is **reply-only**. You respond within an existing conversation; you can't start a new outbound thread to a patient from the inbox. Conversations begin from patient-facing activity such as shipment notifications.
</Note>

Your team marks your own patient conversations as read. Blend staff can't clear your unread count on your behalf — what's unread in your inbox reflects what your team has actually seen.

Replies go out as written. No signature is appended automatically, so include whatever attribution your business wants the patient to see.

## How Blend decides which patient a message is from

Inbound messages are matched on phone number. Where a number matches more than one patient record — a shared household phone, a parent managing several children's care — Blend looks for a patient's first or last name in the message text to disambiguate, and otherwise attributes it to the most recently active patient.

<Warning>
  Read the patient name on the conversation before replying with anything clinical, particularly for shared household numbers. The automatic attribution is a best guess, not a verified identity.
</Warning>

## Patient notification preferences

Whether a patient receives messages from Blend at all is controlled per patient by `receive_sms` and `receive_email`:

```json theme={null}
{
  "receive_sms": true,
  "receive_email": true
}
```

<Note>
  These flags only take effect if you have authorized Blend to send patient communications on your behalf. If you haven't, Blend doesn't contact your patients and all patient communication stays with your business.
</Note>

Set them at [patient creation](/guides/create-a-patient) or update them later with `PATCH /patients/{patient_id}`.

## Comments are not patient messages

Comments on an order or prescription are the internal channel between your team and Blend pharmacy staff — questions about a stuck order, a replacement decision, a clarification on a prescription. Patients never see them. Anyone who has commented on a thread is notified by email when it's added to, which is how replacement approvals and declines reach the person who asked.

<CardGroup cols={2}>
  <Card title="Create a patient" icon="user-plus" href="/guides/create-a-patient">
    Set `receive_sms` and `receive_email`
  </Card>

  <Card title="Webhooks" icon="webhook" href="/guides/webhooks">
    Get alerted when a message arrives
  </Card>

  <Card title="Update a patient's details" icon="user-pen" href="/api-reference/patients/update-a-patients-details">
    Change notification preferences
  </Card>

  <Card title="Multi-brand support" icon="sitemap" href="/guides/multitenancy">
    Messaging across a brand's businesses
  </Card>
</CardGroup>