Forms & Policies | Orchid Wellness | Carrollton, TX
👩🏾‍💻 Telehealth available in TX, NY, VA & DC — book at telehealth.myorchidwellness.com
Patient Resources

Forms & Policies

Patient intake forms, the MyOrchidWellness App privacy policy, terms of use, and practice policies, all in one place. Orchid Wellness accepts insurance for in-person and select telehealth visits in Texas. Patients in NY, VA, and DC, and Texas telehealth patients whose insurance we do not accept, are seen on a self-pay basis. Questions? Contact us at [emailprotected] or call (469) 892-0194.

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New Patient Forms

Complete before your first visit to save time at check-in

New patients are asked to complete intake paperwork before their first appointment. Forms can be completed electronically through the MyOrchidWellness App or the patient portal. If you have trouble accessing any form, call us at (469) 892-0194 and we will assist you.

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New Patient Registration
Personal information, insurance details, and emergency contact. Required for all new patients.
Complete via Patient Portal
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Medical History Form
Past medical history, current medications, allergies, and family health history.
Complete via Patient Portal
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HIPAA Authorization & Consent
Authorization for treatment and acknowledgment of HIPAA privacy practices.
Complete via Patient Portal
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Telehealth Consent Form
Required for patients receiving care via telehealth. Covers scope, limitations, and patient rights.
View Policy Below
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MyOrchidWellness App
Privacy Policy

Orchid Wellness, PLLC • Effective: June 4, 2025

Welcome to the MyOrchidWellness App, operated by Orchid Wellness, PLLC. Your privacy is important to us. This Privacy Policy explains how we collect, use, disclose, and protect your information when you use the App. By using the App, you agree to the terms of this Privacy Policy.

01 Information We Collect

  • Personal Information: Name, date of birth, address, email, phone number, and insurance details
  • Health Information: Medical history, prescriptions, lab results, appointment history, and MySWANS™ wellness tracking data
  • Usage Information: Device details, app interactions, and IP address
  • Location Information: If permitted, your location may be accessed to personalize services

02 How We Use Your Information

We use your information to provide clinical services, schedule appointments, offer telehealth, track wellness goals through MySWANS™, process payments, and improve the App experience. Your health information is used solely in connection with your care at Orchid Wellness.

03 How We Share Your Information

We never sell your information. Your data is not shared with advertisers, data brokers, or third parties for marketing purposes.

We share your information only in the following circumstances:

  • With your healthcare providers for the purpose of your treatment
  • With trusted partners who support the App under strict confidentiality agreements
  • As required by law, including applicable health reporting obligations

04 Your Choices and Rights

You may access, update, or request deletion of your personal information at any time by contacting us at [emailprotected] or calling (469) 892-0194. We will respond to all requests within a reasonable timeframe.

05 Data Security

We protect your data with encryption, secure servers, and privacy controls consistent with HIPAA requirements. No method of transmission over the internet or electronic storage is 100% secure. We are committed to using commercially reasonable safeguards to protect your information.

06 Children's Privacy

The MyOrchidWellness App is not intended for children under 13 without verified parental consent. If you believe a child under 13 has provided information without appropriate consent, please contact us immediately.

07 Changes to This Policy

We may update this Privacy Policy from time to time. When we do, we will notify you through the App or by email. Continued use of the App following any update constitutes your acceptance of the revised Policy.

08 Contact Us

Privacy Questions or Requests
Orchid Wellness, PLLC
3620 N Josey Lane, Suite 117
Carrollton, TX 75007

[emailprotected]
(469) 892-0194
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MyOrchidWellness App
Terms of Use

Orchid Wellness, PLLC • Effective: June 4, 2025

These Terms of Use govern your access to and use of the MyOrchidWellness App and its related services, operated by Orchid Wellness, PLLC. By using the App, you agree to these terms. If you do not agree, please do not use the App.

01 Eligibility

You must be at least 13 years old, or the legal age of majority in your jurisdiction, to use this App. Users under the age of 18 may only use the App under the supervision of a parent or legal guardian who agrees to be bound by these Terms.

02 Medical Disclaimer

The MyOrchidWellness App is not intended to replace in-person medical advice, diagnosis, or treatment. Always consult your licensed healthcare provider for any medical concerns. Use of the App does not establish a provider-patient relationship unless and until you complete registration and are seen by an Orchid Wellness provider.

03 Services Provided

Through the App, you may access the following services:

  • Schedule virtual and in-person appointments
  • Access telehealth services (available in Texas, New York, Virginia, and Washington DC)
  • View lab results, prescriptions, and health records
  • Communicate with your healthcare provider
  • Track wellness goals using the MySWANS™ framework
  • Purchase health and wellness products from the Orchid Wellness online store
  • Apply for Cherry financing for eligible services

All services are subject to change and may require additional consent or payment.

04 Account and Security

You are responsible for maintaining the confidentiality of your login credentials. You agree to notify us immediately at [emailprotected] if you become aware of any unauthorized use of your account. Orchid Wellness reserves the right to suspend or terminate access at our discretion.

05 Privacy

Use of the App is subject to our Privacy Policy. By using the App, you consent to our collection, use, and disclosure of your information as described in that Policy.

06 Payment Terms

Some features and services require payment, including consultation fees, medications, and subscription plans. Payment plans may be available through Cherry. By using Cherry, you agree to Cherry's own terms and disclosures. Orchid Wellness is not responsible for the terms of third-party financing providers.

07 Intellectual Property

All content, trademarks, logos, and materials in the App, including the MySWANS™ framework and name, are the property of Orchid Wellness, PLLC or its licensors. You may not reproduce, distribute, or exploit any content without prior written permission.

08 User Conduct

You agree not to misuse the App or interfere with its functionality, use the App for any unlawful, abusive, or harmful activity, or impersonate any person or misrepresent your identity. Orchid Wellness reserves the right to restrict or terminate access for any conduct that violates these Terms.

09 Third-Party Services

The App may contain links or integrations with third-party services, including Cherry, Sworkit, and Tebra. Orchid Wellness is not responsible for the privacy practices, content, or terms of any third-party services. Your use of those services is governed by their respective terms.

10 Limitation of Liability

To the fullest extent permitted by applicable law, Orchid Wellness, PLLC shall not be liable for any indirect, incidental, special, consequential, or punitive damages arising from your use of the App or any services provided through it. Our total liability shall not exceed the amount paid by you to Orchid Wellness in the 12 months preceding the claim.

11 Governing Law

These Terms are governed by the laws of the State of Texas. Any disputes arising under these Terms shall be resolved exclusively in the courts located in Dallas County, Texas.

12 Changes to These Terms

We may update these Terms at any time. We will notify you via the App or by email when material changes are made. Continued use of the App following any update constitutes your acceptance of the revised Terms.

13 Contact Us

Questions About These Terms
Orchid Wellness, PLLC
3620 N Josey Lane, Suite 117
Carrollton, TX 75007

[emailprotected]
(469) 892-0194
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Cancellation Policy

Orchid Wellness, PLLC • In effect for all appointments

We understand that schedules change. We ask that you notify us as early as possible so that your appointment time can be offered to another patient who needs it.

01 Cancellation Notice

Please cancel or reschedule your appointment at least 24 hours before your scheduled visit. Cancellations can be made online through the patient portal, through the MyOrchidWellness App, or by calling (469) 892-0194.

02 Late Cancellations and No-Shows

Cancellations made less than 24 hours before a scheduled appointment, and appointments missed without notice, may be subject to a late cancellation or no-show fee. This fee helps us sustain availability for all patients. If you have extenuating circumstances, please contact us directly and we will do our best to accommodate you.

03 Rescheduling

We encourage you to reschedule rather than cancel whenever possible. Rescheduling with adequate notice does not incur any fee. Book a new time online at any time through the patient portal or App.

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Payment Policy

Orchid Wellness, PLLC • Insurance and self-pay accepted

Orchid Wellness accepts insurance for many in-person visits in Texas and for qualifying telehealth visits that may be billed to insurance. Patients in New York, Virginia, and Washington DC, as well as Texas telehealth patients whose insurance we do not accept, are seen on a self-pay basis. Please review the section below that applies to you, or contact us before your visit if you have questions about coverage.

01 Insurance Billing — Texas In-Person & Qualifying Telehealth

Orchid Wellness accepts insurance for in-person visits at our Carrollton, TX clinic and for qualifying telehealth visits that are billable to insurance. If you are a Texas patient with insurance we accept, your visit will be billed to your plan and you will be responsible for any applicable copay, coinsurance, or deductible amounts at the time of service.

Some telehealth visits conducted with Texas patients may also be billed to insurance depending on the nature of the visit and your specific plan. Chelsea's team will confirm your coverage and billing eligibility before your appointment.

To confirm whether we accept your insurance plan, please call (469) 892-0194 or email [emailprotected] before scheduling.

02 Self-Pay — NY, VA, DC, and Texas Telehealth (Out-of-Network)

Patients receiving telehealth care in New York, Virginia, and Washington DC are seen on a self-pay basis. Texas telehealth patients whose insurance is not accepted by Orchid Wellness are also seen as self-pay. Self-pay fees are due at the time of service.

We accept all major credit and debit cards, HSA and FSA cards where applicable, and cash for in-person visits. Cherry financing is available for self-pay patients with eligible treatment plans.

03 Out-of-Network Reimbursement

Self-pay patients whose insurance plan offers out-of-network benefits may be eligible for partial reimbursement. We can provide an itemized receipt (superbill) upon request that you may submit to your insurance carrier. Reimbursement is not guaranteed and is subject to your individual plan terms. We recommend contacting your insurer before your visit to understand your out-of-network coverage.

04 Cherry Financing

Cherry patient financing is available for self-pay services and treatment plans at Orchid Wellness. Apply at pay.withcherry.com/orchid-wellness. Decisions are returned in seconds with no hard credit pull to apply. Affirm and Zelle are also accepted.

05 Membership Plans

Orchid Wellness offers monthly membership plans that provide reduced per-visit costs and additional benefits for ongoing patients. Memberships are a self-pay arrangement and are not billed to insurance. Membership fees are billed monthly via the payment method on file and may be cancelled with 30 days written notice. Visit the memberships page for full plan details.

06 Lab and Ancillary Fees

Lab work ordered during your visit may carry additional fees depending on the tests ordered and your insurance coverage. For insured patients, labs may be billed separately to your plan. For self-pay patients, lab fees will be discussed before ordering. Chelsea will not order testing without first reviewing anticipated costs with you.