This study seeks to provide empirical evidence about how health-related questions are answered in text reference service to further the understanding of how to best use texting as a reference service venue to fulfill people’s health information needs. Two hundred health reference transactions from My Info Quest, the first nationwide collaborative text reference service, were analyzed to identify the types of questions, length of transactions, question-answering behavior, and information sources used in the transactions. Findings indicate that texting-based health reference transactions are usually brief and cover a wide variety of topics. The most popular questions are those seeking general factual information about the human body, medical/health conditions, diseases, or medical concepts/jargons. Great variance is discovered between the question-answering behavior, with only a little more than half of the answers containing a citation to information sources. The study will inform the practice of health reference service via texting and help libraries make evidence-based decisions on establishing service policies and procedures, providing training for librarians, and ultimately implementing the service successfully.