Use this when a patient says they texted the office, but the message never appears in TrackStat.
Business texting numbers receive SMS only. They cannot receive Apple iMessage or Google RCS. Plain text messages travel as SMS. Images, PDFs, and other files travel as MMS. Many file types and sizes are not reliably delivered by carriers to business numbers.
Always start here
Confirm the office texting number the patient used.
Open that patient’s conversation history in TrackStat.
Ask whether their sent message shows Delivered or Failed / Not Delivered.
Ask if they have an iPhone or Android.
Ask if they included an image, PDF, document, or video.
If the text is not in conversation history, TrackStat did not receive an SMS (or supported MMS). Do not assume TrackStat failed to receive the message until you confirm how the patient sent it.
Blue bubbles vs. green bubbles (iPhone)
Blue = iMessage. Sent over Wi‑Fi or cellular data through Apple. TrackStat cannot receive it.
Green = SMS/MMS. Sent through the mobile carrier. This is the format TrackStat can receive.
A blue “Delivered” only means Apple handled an iMessage. It does not mean an SMS reached TrackStat.
Android bubble color is not reliable (it changes with the app and theme). Ask if RCS / Chat features are on. RCS is not SMS and usually will not arrive on a business number.
SMS needs the cellular network. iMessage and RCS can send over Wi‑Fi. If the patient is on Wi‑Fi only (no signal, airplane mode + Wi‑Fi, no SIM), they may send a message TrackStat never gets.
When the patient sent an image, PDF, or other file
If the patient tried to text a photo, PDF, document, or video, the message must go as MMS. Carriers often strip the media, reject the file, or fail the entire message when the type or size is not well supported on the path from the patient’s phone to a business number.
Situation | What typically happens | Why it fails |
iPhone HEIC / HEIF photos (default “High Efficiency” camera format) | Image is removed or the message fails. Clinic sees only text (or nothing). Patient may see a delivery error. | Many carriers (especially AT&T) reject or strip HEIC. |
PDFs | Message fails or the PDF is stripped. | Poorly supported from iPhones to non-iMessage numbers. Many carriers and Android devices have limited or no PDF support over MMS. |
Word, Excel, PowerPoint, or other office docs | Almost always fails. | Not part of the standard MMS media set. |
Videos (even short ones) | Frequently fails or is heavily compressed/rejected. | Size limits are tight and format support varies. |
Large images (high-res photos, uncropped screenshots, multiple attachments) | Rejected or media stripped. | Carriers commonly enforce limits around 300–600 KB to 1 MB for reliable MMS. |
ZIP / archives, audio, WebP, SVG, TIFF, BMP, or other less common formats | Rarely arrives intact. | Limited or no support across carriers. JPEG and PNG are far more reliable. |
Practical patterns clinics see
Patient takes a photo of an insurance card, ID, or injury on a modern iPhone → sends HEIC → clinic never receives the image.
Patient tries to text a PDF of a form or referral → fails because of iPhone + non-iMessage path limitations.
Patient sends a large, high-resolution photo or short video → exceeds carrier size limits.
Patient is on Wi‑Fi only or has MMS disabled → media never leaves their phone (plain SMS text might still go through).
Message is part of a group thread with mixed devices → higher chance of media being dropped.
What works most reliably
JPEG or PNG images, preferably under ~500 KB.
On iPhone: patient should set Settings → Camera → Formats → Most Compatible (forces JPEG instead of HEIC).
One reasonably sized photo at a time rather than multiple large files.
Avoid PDFs, documents, videos, and HEIC for anything important.
For IDs, insurance cards, and forms: use a HIPAA-compliant online intake form instead of SMS when possible.
These limitations come from the carrier networks and handsets. Even when a provider lists a format as “accepted,” downstream carriers and devices frequently reject or strip it. This is not a TrackStat receive failure.
How to resend as SMS - iPhone
Fastest fix:
Press and hold the blue bubble.
Tap Send as Text Message (may also say Send as SMS).
Confirm the bubble turns green.
If that option is missing:
Go to Settings → Messages.
Turn on Send as SMS.
Send a new short text such as “Testing.”
Confirm the new bubble is green.
Still blue? Settings → Messages → turn iMessage off, send the test, then turn iMessage back on. Leave Send as SMS on.
How to resend as SMS - Android
Google Messages:
Messages → profile → Message settings → RCS chats (or Chat features).
Turn RCS chats off.
Send a new short text to the office number.
Samsung Messages: three-dot menu → Settings → Chat settings / RCS chats → turn off, then resend.
Other checks
The patient texted the wrong number (old number, voice line, or a provider’s personal cell).
Their phone is not in airplane mode and has cellular signal.
Search TrackStat by the sending mobile number, not only the patient name (shared numbers can land on a different card).
Note their carrier (T‑Mobile, Verizon, AT&T, etc.) if a green SMS still shows Failed.
For media: confirm they used a supported format (JPEG/PNG) and reasonable size, and that MMS is enabled on their phone/plan.
Prove inbound SMS works
From a staff phone, send an SMS (green on iPhone; RCS off on Android) to the office texting number. If that test appears in TrackStat, receiving is working and the problem is the patient’s device, send method, or file type/size.
What to tell the patient
“On an iPhone the text to our office needs to be a green bubble, not blue. Press and hold the blue message and tap Send as Text Message. On Android, turn off RCS / Chat features and send it again.
If you’re sending a photo, use a regular JPEG (on iPhone go to Settings → Camera → Formats → Most Compatible). Keep it reasonably small and send one at a time. PDFs, documents, and videos often don’t arrive. For forms or cards, our online intake form is more reliable.”
Keywords: patient sent image not received, HEIC photo failed, PDF text not arrived, MMS attachment stripped, patient texted photo insurance card, JPEG PNG vs HEIC, file too large for text, MMS not supported.