HomePatient Forms & PoliciesGeneral Consent
Required at Intake
General Consent
How we collect, use, and share information to provide care; communications policy; HIPAA acknowledgment; and key client rights.
The full General Consent is provided as a PDF.
Use the Download PDF button above to read the complete document. You’ll review and sign this form through Jane, our practice-management system, when you schedule a visit as a new client.
If you’d like a copy of an earlier version, or if you have a question about anything in this document, email admin@bayoucitybreastfeeding.com. We won’t begin treatment until you’ve had the opportunity to review the documents and ask questions.
What this document covers
The General Consent covers the practical foundation of our relationship with you as a client. It describes how Bayou City Breastfeeding may collect, use, and share information to provide care; how we communicate with you between visits; your acknowledgment of the Notice of Privacy Practices; and the key client rights you can exercise at any time, including the right to ask questions, decline a recommended service, and end the relationship.
How it fits with the other forms
This is one of the four core intake documents (along with the Notice of Privacy Practices, the Good Faith Estimate, and the Payment-Related Consent), plus the Master Intake Acknowledgment that confirms you have reviewed all four. New clients receive these through Jane, our practice-management system, when an appointment is scheduled.
Questions before you sign?
Email admin@bayoucitybreastfeeding.com or call (281) 305-0411. We’re happy to walk through any section with you before your first visit.
Ready to schedule?
When you book a visit, Jane sends you the intake documents and the consent for the service you’re scheduling. Request Appointment or call (281) 305-0411.