A multi-activation reamer optionally includes modular activation and pulse confirmation blocks for activating the reamer and confirming activation. A reamer activation signal may be communicated downhole, optionally using an activation sequence of drill string flow and rotation detectable by downhole sensors. An on-board controller receives the activation signal and opens an activation flow path in the activation block to hydraulically actuate the reamer arms. A pulse flow path is also opened in the pulse confirmation block, optionally using pressure from the activation flow path. Flow along the pulse flow path is modulated to generate a flow pattern detectable uphole of the reamer to confirm activation of the reamer.