Phone Trees

Introduction to phone trees

A phone tree or auto attendant presents a caller with two or more options when they call your Spruce number. Adding a phone tree helps you triage inquiries, increase efficiency, and manage patient needs any time of day. Practices using Spruce commonly have two phone trees, one for clinic hours and one for after hours, set up to match their business schedule. 

For example, if a caller dials your Spruce number during business hours they may hear:

Press 1 if you are a new patient, press 2 if you are an existing patient and would like to speak to a provider, press 3 if your question is related to billing. 

If a caller dials your Spruce number after hours they may hear:

Press 1 if this is non-urgent and can be addressed the next business day, press 2 if this is urgent and you'd like to page the on-call provider. 

Phone trees are available to customers on our Communicator plan ($49/user/month). Customers cannot create their own phone tree. Please continue reading this resource for directions on how to submit your phone tree request to Spruce Support so that it is configured and added to your account. To submit a phone tree request, navigate to your Spruce settings, then "Phone & SMS", then click "Phone Tree Request". To upload the recordings for your tree in the Spruce interface navigate to Settings < Phone SMS < Greetings & Prompts. 

Phone tree best practices

When creating your phone tree be sure to have the patient experience in mind. Callers often find long greeting messages and multiple levels of options to be frustrating and we find that more complex phone trees have a higher instance of hang-ups (you will see these noted in the call record as a missed call with the notation [Start] showing that they hung up without making a selection). We suggest no more than four options for a standard phone tree, with only a 'Directory' option leading to additional options. The best approach to phone trees is to create them as a representation of your practice- if only one person is answering phones you may not need a phone tree; if two people are answering different types of calls you may only need two branches. We discourage customers from creating many branches that all route to the same staff person as this generally causes frustration for patients without helping your practice to organize. Feel free to ask us for advice on how best to set up your tree!

Phone trees can be an excellent organizational tool for your practice! We can set each option on the phone tree to auto-assign conversations to a specific team or staff member, this means those conversations would appear in a specific mailbox rather than in the All Inbox. This feature can be requested by using the workflow request form linked on the confirmation page when you complete your phone tree request. Be sure to ask about this feature when setting up your phone tree! 

Phone tree templates

These phone tree templates are meant to guide you so that you understand the parameters to design your phone tree. You do not need to follow these templates exactly, they only serve to provide examples of common ways customers outline their phone tree. 

  • Department by extension
  • Team member by extension
  • Language by extension 
  • Urgent escalation 

Clinic hours templates

Department by extension 

The following template is used to direct patients to a specific "department." It opens with a main greeting that welcomes callers to your practice and directs them to select an extension. You can outline you phone tree so that each extension rings a unique number or group of teammates, or so that a given extension does not ring, and instead goes directly to voicemail. Each extension can have a unique audio file for the voicemail greeting. In the example below, the voicemail greetings are outlined in the black text and white bubble background. 

Team member by extension 

The following template is used to direct patients to a specific staff member. It opens with a main greeting that welcomes callers to your practice and directs them to select an extension. Each extension can ring a different provider or group of providers. Each extension can have a unique audio file for the voicemail greeting. In the example below, the voicemail greetings are outlined in the black text and white bubble background. 

Language phone tree

The following template is used to direct patients to different people and voicemail greetings based on their preferred language. It opens with a main greeting that welcomes callers to your practice and directs them to select an extension. Each extension can have a unique audio file for the voicemail greeting––so each extension has a voicemail greeting spoken in the specified language. In the example below, the voicemail greetings are outlined in the black text and white bubble background. 

After hours template

Urgent escalation 

The following template is used to direct patients to specific extensions that would notify you after hours. It opens with a main greeting that explains they have reached your practice after hours and it directs them to select an extension. In this example, the extensions are urgent and non-urgent. The non-urgent extension goes directly to voicemail, and the urgent extension rings the on-call doctor. A notification system can also be enabled so that the on-call doctor receives an SMS text notification indicating that an urgent voicemail has been left. 

Call Forwarding 

Once your phone tree is created, you will have a group for each extension which we call a Ring Group. Ring Groups define which phone(s) should ring when a certain phone tree extension is selected. This is to ensure that the right team member(s) is being reached. Ring Groups don't exist by default in your account, they are created for you by the Spruce Support team when they configure a phone tree on your account. 

Each Ring Group contains a list of external phone numbers, VoIP phones, and/or teammates in your organization. You can manage which phones ring when a given phone tree extension is dialed by adjusting the phone numbers selected to ring in each Ring Group. To clarify, you can have a phone tree with just one or multiple Spruce business numbers. Team members are able to take calls from any extension directly on their cell phone or VoIP phone, as long as they're listed in the Ring Group for the specified extension. Each "item" (i.e., a VoIP phone, phone number, or teammate) in a Ring Group can be enabled or disabled individually. 

For example, changing your Ring Group settings would allow you to do the following:

  • Route calls to a different desk phone or person based on who's working in the office on a particular day.
  • Ring the appropriate provider after-hours based on who is on-call for a given shift.
  • Forward calls to a covering physician when a provider goes on vacation.

Manage existing Ring Groups 

  1. Select the Gear Icon to open your Settings.
  2. Select Ring Groups.
  3. Select + Add Number or + Add VOIP Phone or Teammate to add cell phone numbers, desk phones, or teammates. If you select a teammate, the cell phone number associated with that teammate's Spruce account will ring. 
  4. Select the toggle to enable (blue) or disable (gray) any numbers.
  5. Select the Three Dots icon to the far right of each row to remove an item from a Ring Group.

Simultaneous and sequential dialing

When you request to build your phone tree with Spruce Support, you can elect one of the two behaviors for each extension's Ring Group:

  • Simultaneous ringing: all enabled numbers in the Ring Group will ring at the same time. The first person to pick up will connect with the caller; the other call attempts will be dropped once the call is answered.
  • Sequential ringing: the enabled numbers in the Ring Group will ring one at a time, starting with the number that has gone the longest without answering a Spruce call, and skipping any numbers that are currently engaged in an active Spruce call. This is commonly known as Round Robin.

How to set up a phone tree 

A phone tree is only available if you are on the Communicator plan so please upgrade before submitting. Start the process by watching this video on how to properly fill out the form, then navigate to your Spruce settings, "Phone & SMS", then click "Phone Tree Request" and upload your recordings. You can direct requests regarding your phone tree to our configurations team at Please note, phone tree requests take 3-5 business days for us to implement after we receive your request and all recordings. 

Submit a Phone Tree Request

When you open the phone tree request form you will be asked what phone number the tree is for, this is the phone number you would like to direct to your phone tree. Generally this would be your main office number. The form also asks when the tree should be active; you will submit a different request for your business hours and after hours tree.

On the next screen you will decide on how many options your tree will have and whether the phone will ring first or go directly to the main greeting menu. Some practices prefer to have staff answer calls immediately when possible, others prefer to have the phone tree triage calls before any phones ring. Finally on this screen you will add the name of the recording you have uploaded for your main greeting.

Each subsequent screen allows you to define actions for an individual option. These are the possible actions:

  1. Ring through then record a voicemail.
    • This is common when the extension is for a department or individual who will answer calls during the time the tree is active but may not always be available.
  2. Play greeting then record a voicemail.
    • This is often used for providers who will not answer their extension during the time the tree is active but would like to receive voicemails.
  3. Play greeting then end the call.
    • This is most often used for information recordings, such as a recording giving business hours, fax number, directions, etc.
  4. Urgent Escalation
    • Most often used in after hours phone trees to contact a provide in the case of an urgent matter.
  5. Forward the call outside your organization.
    • This might be an outside billing service, an after hours nurse line, a suicide hotline or other outside entity that you work with to serve your patients.
  6. Present a directory with sub options for members of your team to be reached directly.
    • Be sure to list all staff and extensions in your recording for this option.
  7. Transfer the call to another Spruce number within your organization.
    • This is often used to connect a caller to a provider's direct line.

After selecting actions for all of your options and identifying the names of the recordings needed for each, you will be able to review all information and then submit your request. The confirmation screen will prompt you to read more about Workflow Automation if you're interested in adding assignment or text backs to your tree.

Need a bilingual phone tree?

To submit a request for a bilingual phone tree, please submit 2 phone tree request forms, one for each language, and we will combine them into one phone tree. 

How to record and upload audio greetings 

You can use a voice recording app (like Voice Memos on an iPhone or Mac) to record your audio files for each extension. Recordings can be in the .mp3, .wav, .mp4 or .m4a format.

The quality of your recordings will be apparent to your caller. Be sure to speak clearly without background noise, and please listen to the recording before sending it to Spruce to ensure your voice is audible.

To upload your recordings navigate to Spruce Settings > Phone & SMS > Greetings & Prompts to upload all the recordings that you have created. Be sure to title the recordings appropriately with an adequate description that will make it easy for the Spruce Support team to identify which recording to use for what part of the phone tree. You can always navigate back to the Greetings & Prompts section to replace the audio file for any part of the phone tree in the future. 

Make adjustments to an existing phone tree

Edit Existing Phone Tree 

Update structure and extension or branches

Please submit all phone tree edits (except greetings) via email to You do NOT need to fill out the phone tree request form to submit edits to an existing phone tree. Please note, phone tree updates take 3-5 business days for us to implement after we receive your request. If the edit entails replacing audio files, please upload in app instructions below.

Replace audio files for an existing phone tree

If you're looking to replace the audio files on an existing phone tree, without any changes to the phone tree structure please log into Spruce on your computer go to Settings, Phone & SMS, Greetings & Prompts. 

  1. Confirm that the old recordings are already listed in this section (message Team Spruce if you do not see them)
  2. Recordings that are currently used on your phone tree will be labeled as “In Use On” whichever phone tree they are part of.
  3. If you want to use the existing recording in the future please download it before replacing the audio. At this time it is not possible to store the old recording in Spruce when not in use.

  1. Find the recording you would like to replace and click on the "Edit:
  2. Select "Replace Audio" (upper right)
  3. There you can either upload an audio file from your computer by selecting "Select Audio File" 
  4. If you prefer to record one right now, select "Record Audio" then click the red microphone button to begin recording and then click the same place with the square stop icon to stop recording. 
  5. Either way make sure to name your recording and a description. Tip to add the date to your title. 

Note: If you originally shared your recordings via email or Spruce Support thread (our old system) and you want to replace an audio file, you should upload your new audio file under Greetings & Prompts and then email the to request that the new file be inserted into the tree. Any greetings that exist in Greetings & Prompts can be replaced on your side in the future. If you want to replace the entire phone tree and all greetings you can follow instructions above on creating a new phone tree by uploading all greetings and emailing support the structure. 

Video of Replacing Audio for Existing Phone Trees or Voicemails

Overriding your schedule

Once your schedules are set up for your phone trees, they will automatically rotate. Occasionally, you may want to switch to after-hours earlier than your schedule designates or even turn off the schedule entirely. Within your settings you have the ability to manipulate this. 

To override the automated behavior, go to your Settings, Phone & SMS and then select the number. If your phone tree is currently applied to a schedule, you'll see an "Override" button, which allows you to override your schedule and enable a different phone tree for a temporary period of time. For example, if your practice is closing early one day, you can click "Override" and enable your After Hours phone tree, which will stay active until your "Clinic Hours" tree is automatically set to become active at a later day / time.

Watch video: Phone Trees and Schedules - Manual Override 

Managing your Phone Trees for Holidays

If a Holiday where your practice will be closed is coming up, you have the ability to add those hours to your Schedule ahead of time (up to a year in advance) and configure which phone tree will be active during that Holiday schedule period.

To add a Holiday exception to your schedule, navigate to "Schedules", click "edit" and choose "Add Holidays". After configuring those hours, you'll then navigate to "Phone & SMS", then "Phone Numbers", then click into the number you want to manage and make sure to add the appropriate phone tree menu to the new "Holiday" time period. It's simplest to just use your "After Hours" phone tree menu for that period of time but you can also work with the Spruce Support Team to get a generic "Holiday Phone Tree" created and have that be active during that period instead.

Watch video: Managing your Phone trees for Holidays 

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