The manage link Made before anything is sent, because the confirmation has to embed it. It expires with the appointment rather than with the booking, so a visit booked three months out still has a live link on the day.
A text To the number on the booking: the clinic, the time, the doctor and a reference number. Anyone who has opted out is skipped rather than messaged anyway, and the skip is written down alongside the sends.
An email A receipt as a PDF, a calendar file, and the reschedule link. On a group booking every member with an address gets their own copy — the whole family, not just whoever tapped the link.
Your screens One broadcast goes out to the realtime channel the clinic’s dashboards already listen on. Reception doesn’t refresh anything and nobody has to be told.
The audit line The patient’s name, the doctor, that it came in through online booking, and whether it was covered, free or pay-at-clinic. Written whether anyone ever reads it or not.