How to send a HIPAA fax from Gmail or Outlook

In Gmail or Outlook, email one PDF to the recipient's fax number at fax.faxpigeon.com, such as 3125550142@fax.faxpigeon.com, from the address on your Fax Pigeon account, and it goes out as a fax from your own number. Every paid plan sends by email, from $4.99 a month billed annually for 200 pages, with a signed BAA. For patient records, the mail service needs its own BAA with your practice too, because it carries the email first (HHS).

What are the steps in Gmail and Outlook?

1. Save the document as a PDF. In Word, choose File, then Save As or Save a Copy, and pick PDF. On a Mac, press Command-P and click PDF in the print window.
2. Address a new email to the number. In the To line, type the ten-digit fax number followed by @fax.faxpigeon.com. One fax number per email.
3. Send from the address on your account. If Gmail or Outlook offers several From addresses, pick the one on your Fax Pigeon account. Everyone in the practice sends from the address on their own account.
4. Attach the PDF. One PDF per email, up to 250 pages and 25 MB.
5. Send, then watch your inbox. One email says the fax is on its way, a second that it was delivered. The fax shows in Sent with its delivery certificate.

The browser is the other route, on a Mac or a Windows PC with nothing to install: upload a PDF or an image, enter the number and send.

Why didn't my email go out as a fax?

Check these five first.

• The domain has no DMARC record. DMARC is a DNS record that lets receiving servers confirm mail really came from your domain. Fax Pigeon faxes only mail that passes it. Whoever manages the domain adds the record (Google Workspace steps, Microsoft 365 steps).
• It came from another address. Only the address on a Fax Pigeon account in a paid practice can send.
• The attachment is not one PDF. A Word file, a second attachment, or a Drive or OneDrive link in place of the file is refused. Export the document as a PDF and attach only that.
• The PDF is over 250 pages or 25 MB. Split it and send each part in its own email.
• The email names more than one fax number. One number per email.

For the last three, Fax Pigeon replies with the reason. An email that fails either of the first two gets no reply.

Is it HIPAA compliant to send a fax from Gmail or Outlook?

It can be, when your email service has its own BAA with your practice. The email passes through your mail provider before it reaches Fax Pigeon, so the provider handles the patient information first. HHS treats a cloud provider that creates, receives, maintains or transmits electronic protected health information (ePHI) for a covered entity as a business associate, even when it holds only encrypted data, and it limits the conduit exception to transmission with no more than temporary storage (HHS cloud guidance). Your mailbox keeps the PDF in Sent until you delete it. A covered entity may let a business associate handle PHI once it has satisfactory assurance, documented in a written contract (45 CFR 164.502(e)).

Google says customers who have not signed its BAA must not use PHI in Google Workspace, and an administrator accepts the BAA in the Admin console (Google). Gmail is among the Workspace services it covers (Google Cloud); a personal @gmail.com address is not a Workspace account. Microsoft makes its BAA available through the Microsoft Online Services Data Protection Addendum, with Exchange Online among the covered services (Microsoft). Without such an agreement, the browser route keeps the mail provider out of it.

The fax service is the second agreement, and every Fax Pigeon plan includes a signed BAA, executed at signup.

For the fax itself, HHS's FAQ on faxing for treatment gives two safeguards: check a number you rarely use with the recipient first, and pre-program the numbers you use often so the information is not misdirected (HHS FAQ). In Gmail or Outlook, a saved contact whose email address is the fax address does the second.

How does Dropbox Fax handle sending by email?

Dropbox Fax sends by email only on a paid plan, starting with Home Office at $9.99 a month for 300+ pages, and none of its ten plans names a BAA. Its terms bar patient information on the service "unless Customer and Dropbox separately enter into a HIPAA Business Associate Agreement."

Dropbox's help article gives the hellofax.com format; the FAQ on its pricing page shows an example at fax.dropbox.com instead. The same FAQ says received faxes are forwarded to your email as PDFs, so each patient fax lands in the mailbox too.

Who should switch from Dropbox Fax?

A practice that emails patient records through Dropbox Fax without a BAA signed with Dropbox, or one that needs more than Dropbox's 5 or 10 senders, should move to Fax Pigeon: the BAA is signed at signup and people are unlimited on every plan. Basic is $4.99 a month billed annually for 200 pages, and the pricing page lists all six plans.

Start the port at Fax Pigeon while the Dropbox account is open: it costs nothing on a paid plan and takes most transfers 5 to 15 business days while Dropbox still serves the number. The full porting steps have the order, and Is Dropbox Fax HIPAA compliant? has the full BAA read.

* Prices last verified October 7, 2026, at each provider's own site. Fax Pigeon is not affiliated with Dropbox, Google, Microsoft or Apple.