Why don't my appointment reminder or recall e-mails send consistently?
Posted by Dustin Taylor on 30 April 2013 11:12 AM

Author: Ed Moffatt

We have received a number of recent reports of the Reminder and Recall e-mails from within Appointment Scheduler not being sent out consistently.  Upon research, the source of the issue in these cases is typically related to using a public mail server for your outgoing mail (such as AT&T, hotmail, or gmail) which requires additional, manual, authentication after sending mass e-mail.  

This is not a requirement of PracticeStudio, but is still typically very simple to do (we have included a sample process to accomplish this below.)  That said, it is important to understand why some outgoing mail servers require this so that you can adjust to accommodate your specific situation accordingly. 

Reason for the Requirement

When we send out Reminders and Recalls through PracticeStudio, most outgoing mail servers will see them as an "Email Blast".  An Email Blast is an electronic mailing, sent all at once to a large mailing list. This may be used for valid purposes (such as appointment reminders), but is most commonly used by e-mail "spammers" trying to sell unsolicited products or services.  To prevent spam from being sent through their servers, many mail providers have added manual safeguards that require human interaction whenever they detect usage that looks like an Email Blast (AT&T, Hotmail, and Gmail are three of the larger providers that do this.) 

As such, if you are utilizing any of these public mail servers to send your outgoing mail, your mail provider may "shut off" your service unexpectedly until you do some type of manual authentication.  When this occurs, any e-mails that PracticeStudio attempts to send after service has been temporarily suspended by your provider will not go through to patients. By design, the email providers typically do not notify the sending party that the e-mails are being refused and, as such, PracticeStudio has no way to notify you when this occurs. 

Steps to Resolve

When you discover this type of behavior occurring on your outgoing e-mails, you have two options to address the issue:

  1. Change e-mail service providers to either be self-hosted, or to use a different e-mail host that allows Email Blasts to your authorized customers (this is preferred since it will avoid further interruption of service)

  2. Routinely go through the steps required by your e-mail provider to manually verify your identity. The required frequency and the specific process will vary based on the provider you use (an example of the process is below).  Note: Contacting your email provider to ensure that your usage of their service is approved is recommended to avoid unreported failed e-mails to your patients.

Sample Manual Verification Process

The process below was done to manually verify an e-mail account using AT&T.  Similar processes are used by other providers (i.e. hotmail and gmail) to manually verify identity.

AT&T uses a "CAPTCHA" for their manual verifications.  A "CAPTCHA" is a program that protects websites against automated "bots" by generating and grading tests that humans can pass but current computer programs cannot. For example, humans can read distorted text as the one shown below, but current computer programs can't. They can be irritating to interpret and use, but have become a necessity in the cyber-world to assure there really is a Human Being pulling the strings.


In the case of an AT&T account that won't send Reminders and Recalls, take the following steps (this assumes that you have checked your email settings under Application Options and the Test Email link returns a "Failed" result) :

  1. Go to or and login using the same e-mail username and password as the one you have entered into Application Options.
  2. As soon as your login authenticates, you will get a CAPTCHA such as the above.
  3. Complete the CAPTCHA (in the example above you would type "overlooks inquiry" into the text box).
  4. Typically this is all that is required to re-authenticate your account and allow e-mails to be sent using your credentials.  Occasionally your mail provider may ask you to take additional measures like changing your password, or entering an automated code sent to a cell phone number.  Take any of these additional steps requested to complete the process.
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Comments (1)
Michael J. Miller
14 May 2013 10:06 AM
Well written, Ed, Printing it out to use when we send 1st email... thanks..

Micheal J. Miller DC
Springfield, MO
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