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The consent required depends on the type of message, for example a conversation simply requires them to either message you first or agree to receive SMS verbally, whereas informational messages (appointment reminders) require express consent (verbal or written).

This means for either of these use cases you could get consent from your patients simply by asking them (written or logged consent is not required for the above two use cases).

Please note that opt-out is now required for all business messages, regardless of what type of message you are sending. This does not mean that you have to include opt-out language for conversational texts, but rather that if someone replies STOP, UNSUBSCRIBE, or otherwise requests for you to stop texting them you need to honor that request.

Additional information regarding the consent requirements from US mobile carriers is available here: https://api.ctia.org/wp-content/uploads/2019/07/190719-CTIA-Messaging-Principles-and-Best-Practices-FINAL.pdf#page=12