HomePatient Forms & Policies
Documents · Version 2026.1
Patient Forms & Policies
We maintain the following client-facing policies and consents. Each document shows its current version and effective date. Prior versions are retained for the historical record and are available on request.
For questions, contact admin@bayoucitybreastfeeding.com.
Required at intake
5 documentsEvery client reviews these four documents plus the Master Intake Acknowledgment.
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General Consent
How we collect, use, and share information to provide care; communications policy; HIPAA acknowledgment; and key client rights.
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Notice of Privacy Practices
How we use and disclose protected health information, your rights, and how to file a complaint. Required by HIPAA.
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Good Faith Estimate & Surprise Billing Notice
Your right to a written estimate of expected costs and protections against surprise medical bills under federal law.
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Payment-Related Consent
Payment responsibility, insurance billing, card-on-file, cancellation fees, home-visit fees, and refund terms.
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Master Intake Acknowledgment
Single-page acknowledgment that you have reviewed the four core intake documents.
Service-specific consents
4 documentsReviewed in addition to the intake documents when the corresponding service is scheduled.
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Lactation Treatment Consent
Scope of practice, what to expect, risks, alternatives, telehealth, and AI-supported documentation for lactation visits.
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Chiropractic Treatment Consent
Scope, benefits, risks, and alternatives for chiropractic care provided through Bayou City Breastfeeding.
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Therapeutic Laser Treatment Consent
Therapeutic laser treatment offered as part of chiropractic care: how it works, expected benefits, risks, and contraindications.
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Home Visit Safety Acknowledgment
Safety expectations and conditions that apply when a Bayou City Breastfeeding clinician visits your home.
Optional
1 documentReviewed only if you choose to opt in.
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HIPAA Marketing Authorization
Optional. Authorizes us to use specific information in marketing or educational materials.
Site policies
4 documentsApply to your use of bayoucitybreastfeeding.com.
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Website Privacy Policy
What information bayoucitybreastfeeding.com collects, how it is used, and the choices available to visitors.
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Terms & Conditions
Terms governing your use of the Site, intellectual property, purchases and returns, warranties, limitation of liability, and governing law.
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Medical Disclaimer
Site content is general education, not medical advice; using the Site does not create a clinician-client relationship.
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Accessibility Statement
Our commitment to making the Site usable by everyone, the standard we’re working toward, known limitations, and how to report a barrier.
Ready to schedule?
When you book a visit, Jane sends you the four intake documents and the consent for the service you’re scheduling. You can review them on this page first if you’d like. Request Appointment or call (281) 305-0411.