Spruce review (2026): is it worth $24 a month per user?
HIPAA-focused phone, text and fax for healthcare practices
Black Friday: is there a Spruce sale?
Spruce report card
Fair · out of 4.0 · graded Nov 12, 2026
Best for phone, text and fax for healthcare practices
Spruce gives a practice one inbox for phone, text, video, fax and team chat, with a signed BAA. It does none of scheduling, charting or insurance billing, so you still need an EHR. Integrations and the API are on the $49 plan, and sending texts needs a one-time $19.50 registration.
Who Spruce is for
- Fits if you want one shared inbox for calls, texts and faxes
- Works for a practice that already has an EHR and needs the phone side
Who Spruce is not for
- Not for you if you want scheduling, charting or billing, as it needs a separate EHR
- Watch out: business text sending needs a one-time A2P 10DLC fee of $19.50 per organization
- Pricey if you want call flows, integrations or the API, all on Communicator at $49
- Watch out: desk phone hardware for VoIP is extra
Why Spruce gets a 2.4
Five grades, each with its reason. The GPA is their average: an A is 4 points, an F is none.
- BValue for moneyBasic is $24 a user a month billed monthly, just inside the cheaper quarter of $25. Communicator is $49.
- CFree plan and trialA 14-day trial with no card, and no free plan. The trial does not include sending texts until registration is done.
- CFeaturesPhone, text, fax, chat, call flows and AI transcription do the communication job fully. It is a smaller job than an EHR.
- CEase of useNo store rating on record. You set up numbers, call flows and text registration first.
- BPlatforms and integrationsWeb, iPhone and Android with athenahealth and an API from Communicator. No desktop app listed.
What these grades rest on. Graded from this listing, whose facts were read from Spruce's own pages on 12 November 2026. Not based on using the product, and shorter than our full reviews. How we review and grade.
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<a href="https://toolgpa.com/tools/spruce#review"><img src="https://toolgpa.com/badge/spruce.svg" alt="Spruce: 2.4 GPA on ToolGPA" width="196" height="56"></a>Where Spruce stands among therapy and clinic software
Spruce's GPA of 2.4 is higher than 25 of the 38 other therapy and clinic software we grade, and level with 8.
It stands best on value for money (B, above 32 of 38) and worst on features (C, above 0).
Its paid plans start at $24 a month for each person, against a middle price of $39 for the category: 6 of the 26 others that charge start lower.
On features, ease of use and platforms it scores 2.3 out of 4. 4 tools score higher and cost less.
Each grade against the category
Every bar is all 39 therapy and clinic software we grade, cut by the letter each got. Spruce’s own letter is outlined.
- BValue for moneyAbove 32 of 38, level with 5
- CFree plan and trialAbove 11 of 38, level with 23
- CFeaturesAbove 0 of 38, level with 17
- CEase of useAbove 0 of 38, level with 37
- BPlatforms and integrationsAbove 14 of 38, level with 22
Price against what you get
Each dot is one of 27 therapy and clinic software. Further left costs less, and higher up scores better on features, ease of use and platforms. Point at a dot to see which tool it is.
Features, ease of use and platforms, averaged
What paid plans start at, a month (each step along is roughly double) →
- The best score at each price
- Has a free plan
- No free plan
Keep Spruce, or make your own?
Keep it
To replace Spruce you would be making phone numbers and calls carried over the phone network. That is not a weekend's work, with an AI app builder or without one.
It costs $288 a year.
What you could not
- Phone numbers and calls carried over the phone network.
- Fax numbers connected to the phone network.
- Video sessions that meet health privacy rules.
- One mailbox that several people work at once.
- Texts from a business number, registered with the carriers.
- A real app for iOS and Android. Something home-made would be a web page.
- It is priced for each person, which means accounts and billing for a team.
- What a company asks for before it lets staff use something: SOC 2 and HIPAA.
What this rests on. Spruce’s listing: what it does, where it runs, what it plugs into and what it costs. It is a judgement about the kind of software this is. We have not built a replacement for it, and making your own means looking after it too. How we decide, and every tool’s verdict.
What is Spruce?
Spruce is a communications platform for healthcare practices that puts phone, text, fax, video visits, secure messaging and team chat in one shared inbox. It is not an electronic health record or a scheduling tool. Billing is per user per month, and the vendor says every organization gets a signed BAA.
Worth knowing
- It does not do scheduling, charting or insurance billing; a practice still needs a separate EHR.
- Sending business SMS requires a one-time A2P 10DLC registration fee of $19.50 per organization.
- Integrations and API access are limited to the $49 Communicator plan, and VoIP desk phone hardware is an extra.
- The free trial includes Basic features but not SMS sending, which needs the registration process first.
Key features
- Phone, text and fax in one inbox
- Calls, SMS, e-fax, app-based secure messages and video visits arrive in a customizable shared inbox, with new or ported phone and fax numbers.
- Secure messaging and team chat
- Staff can message patients inside the Spruce app, share files, and talk to each other in internal chat on the same plan.
- Automations for common replies
- Auto-replies, saved and scheduled messages and bulk text broadcasts cut down repeat typing.
- Call routing
- Phone trees and extensions come with Spruce's phone system. Self-service call flows, urgent escalation and after-hours triage are on Communicator.
- AI transcription
- Voicemails are transcribed on both plans. Communicator also transcribes and summarizes call recordings and audio messages.
- BAA and security claims
- Spruce says every eligible organization gets a HIPAA BAA at signup with no extra fee, and describes the platform as SOC 2 Type II audited.
Spruce pricing
As of Nov 12, 2026, Spruce is a paid product with a free trial, starting at $24 per user / month, billed monthly.
- Starts at
- $24 per user / month, billed monthly
- Free plan
- None
- Free trial
- 14-day free trial, no credit card required
| Plan | Price | What you get |
|---|---|---|
| Basic | $24per user / month, billed monthly | Phone, text, video, fax and team chat, a shared inbox, auto-replies and AI voicemail transcription. |
| Communicator | $49per user / month, billed monthly | Adds call flows (IVR), urgent escalation and after-hours triage, integrations and API access, VoIP phone service and AI call summaries. |
Read from sprucehealth.com on Nov 12, 2026. Prices change, so confirm with Spruce before you buy.
Works with
- athenahealth
Spruce alternatives
- Spruce vs Quo
Free trial · from $15/mo
- Spruce vs Dialpad
Free trial · from $15/mo
- Spruce vs RingCentral
Free trial · from $20/mo
- Spruce vs Healthie
Free trial · from $18/mo
- Spruce vs Carepatron
Free plan · from $31/mo
Common questions
Does Spruce have a Windows app?
No Windows app was listed when its pages were read on Nov 12, 2026. Spruce is listed for Web, iOS and Android.
Does Spruce have a macOS app?
No macOS app was listed when its pages were read on Nov 12, 2026. Spruce is listed for Web, iOS and Android.
Is Spruce open source?
Spruce is not described as open source on its own site, as read on Nov 12, 2026.
Sources for this page
The prices, plans, platforms and features above were read from these pages on Nov 12, 2026.