How do reminders and notification preferences work?
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Notification preferences
If a Contact has a Portal Login, they can control what they receive and how (email, text), from their Settings › Notifications page. Staff can also set a contact's preferences on the contact record.
Appointment reminders
Staff users with organization or schedule admin permissions can tweak reminder settings under Organization › Appointments. There you choose the channels (Email and/or SMS) and up to two send times — a first reminder 24–76 hours before and an optional second reminder 1–23 hours before — plus optional custom text.
Reminders go only to contacts who have that notification enabled, and only for appointments still marked Scheduled. If a contact has several appointments within the window, they're combined into a single reminder.