Best HIPAA-Compliant Texting for Therapists (2026): 7 Options Compared
Most therapists text clients, and many do it from a personal phone. The fix is a texting tool covered by a BAA, but the details matter: some cover calls and not texts, some only on certain plans. We make one of the products on this list, so here is the disclosure up front: Stable is included.
Short answer
Texting options for therapy practices include Spruce, OhMD, Klara, and Weave, which offer two-way texting with a BAA (confirm scope); Quo, formerly OpenPhone, whose BAA excludes text messages; SimplePractice Secure Messaging, which is portal-based rather than SMS; and Stable, where AI answers texts itself and hands off in a shared inbox. Check that texts specifically are covered by the BAA.
What to test
- Texts are covered by the BAA. Not just the platform. One popular phone app's BAA explicitly excludes SMS.
- A practice number, not a personal phone. Clients text the practice; staff reply from a shared inbox.
- Who answers after hours. A tool that needs a person to read every text leaves new clients waiting.
- Ownership in the inbox. Two staff replying to the same client is a common failure.
- Crisis messages. What happens when a text contains risk language?
The options, by name
| Option | Texting | Who answers | BAA |
|---|---|---|---|
| Stable | Texts to your practice number in a shared inbox | AI first, then your team | Signs a BAA |
| Spruce Health | Two-way SMS, secure messaging, team inbox | Staff; auto-replies | Automatically for eligible organizations |
| OhMD | Two-way texting in one inbox with calls and chat | Staff, plus AI voice and text agents | Standard BAA in all agreements |
| Klara | Two-way messaging, owned by ModMed | Staff | Confirm with ModMed |
| Weave | Texting, plus an AI Receptionist | Staff or AI | Confirm with Weave |
| Quo (formerly OpenPhone) | Business texting | Staff | Business and Scale plans; SMS not covered |
| SimplePractice Secure Messaging | Portal messages; clients get an email link | Clinician | Yes, for its platform; not SMS |
Vendor details checked against vendor websites and published materials on November 4, 2026. Products change quickly; confirm specifics, including BAA scope, with each vendor before deciding.
For group practices
One shared number, an inbox where each conversation has one owner, and team-only notes matter more than features. See the shared patient inbox.
Where Stable fits
Stable answers texts to your practice number itself: it answers questions, collects appointment requests, and moves anything it can't resolve to your team with the history. Teammates claim a conversation to reply, which pauses the AI, and leave notes the client never sees. It signs a BAA. See the AI text receptionist.
Frequently asked questions
Is it HIPAA compliant for therapists to text clients?
It can be, when clients prefer it, with reasonable safeguards and a vendor that signs a BAA covering text messages. Texting from a personal phone usually has no BAA behind it.
Does OpenPhone (Quo) sign a BAA for texting?
Quo offers a BAA on Business and Scale plans, but its documentation says SMS and MMS are not covered services under that BAA.
Can SimplePractice text clients?
SimplePractice Secure Messaging is portal-based: clients get an email link to read messages. It isn't SMS from a practice number.
Which texting tool answers clients automatically?
Stable's AI answers texts itself and hands off to staff. OhMD and Weave also offer AI agents; Spruce offers auto-replies.
Texts answered, not just received.
See Stable answer a new client's text, collect the request, and hand off to your team.
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