# Policies, Forms & Patient Rights - Link: https://myorchidwellness.com/policies/ - Published: 2026-10-25T01:45:36-05:00 - Author: Chelsea Patient Resources # Policies, Forms and _Patient Rights_ Everything in one place: legal and privacy documents, new patient forms, and practice policies. Questions? [Call (469) 892-0194](https://myorchidwellness.com/policies/4698920194) or send a secure message through your [patient portal](https://www.optimantra.com/optimus/om/patient/login?accessPoint=VzVOMm00cHQxOXpOYVRlWjUzZUlYQT09). On This Page * Legal & Privacy * [Privacy & Legal Policies](https://myorchidwellness.com/policies/#legal-policies) * Patient Forms * [New Patient Forms](https://myorchidwellness.com/policies/#patient-forms) * Web App * [Web App Privacy Policy](https://myorchidwellness.com/policies/#app-privacy) * [Web App Terms of Use](https://myorchidwellness.com/policies/#app-terms) * Practice Policies * [Cancellation Policy](https://myorchidwellness.com/policies/#cancellation) * [Telehealth Consent](https://myorchidwellness.com/policies/#telehealth-consent) * [Payment Policy](https://myorchidwellness.com/policies/#payment) Ready to schedule? Book online anytime through the patient portal. [Book an Appointment](https://www.optimantra.com/optimus/patient/patientaccess/servicesall?pid=ZWRjbjgzRk1UUnRFMVZhZFVwakkwdz09&lid=NEtyNXJFcWwvWnEvYks5OXlSQzFOdz09) ## Legal & _Privacy Policies_ HIPAA rights, website privacy, cookies, and AI chatbot use At Orchid Wellness, we are committed to protecting your information and being transparent about how we use it. The documents below cover your rights as a patient under HIPAA, how our website and web app collect and use data, and how our AI chat tool works. HIPAA Required Notice of Privacy Practices Your rights under HIPAA and how Orchid Wellness may use and disclose your protected health information for treatment, payment, and healthcare operations. [ Website Privacy Policy How myorchidwellness.com collects, uses, and protects personal information submitted through our website, including contact forms and account registration. [ Website Cookies Policy What cookies our website sets, why we use them, and how you can manage or disable them in your browser settings. [ Website AI Chatbot Policy How the AI chat tool on our website works, what it can and cannot help with, and why it is not a HIPAA-secure channel or a substitute for care from your provider. ## 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. All forms are completed electronically through the patient portal at [app.myorchidwellness.com](https://www.optimantra.com/optimus/om/patient/login?accessPoint=VzVOMm00cHQxOXpOYVRlWjUzZUlYQT09). If you have trouble accessing any form, call us at (469) 892-0194 and we will assist you. 👤 New Patient Registration Personal information, insurance details, and emergency contact. Required for all new patients. Complete via Patient Portal 🏥 Medical History Form Past medical history, current medications, allergies, and family health history. Complete via Patient Portal ✍️ HIPAA Authorization & Consent Authorization for treatment and acknowledgment of our HIPAA privacy practices. Complete via Patient Portal 💻 Telehealth Consent Form Required for patients receiving care via telehealth. Covers scope, limitations, and patient rights. View Policy Below ## Orchid Wellness Web App⏎ _Privacy Policy_ Orchid Wellness • app.myorchidwellness.com • Effective: June 4, 2025 This Privacy Policy governs the collection, use, and protection of your information when you use the Orchid Wellness web app at app.myorchidwellness.com. The web app is operated by Orchid Wellness. By using the web 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, web 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 web 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 web 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 [info@myorchidwellness.com](https://myorchidwellness.com/policies/info@myorchidwellness.com) 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 Orchid Wellness web app is not intended for use by 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 web app or by email. Continued use of the web app following any update constitutes your acceptance of the revised Policy. ### 08 Contact Us Privacy Questions or Requests Orchid Wellness 3620 N Josey Lane, Suite 117 Carrollton, TX 75007 [info@myorchidwellness.com](https://myorchidwellness.com/policies/info@myorchidwellness.com) [(469) 892-0194](https://myorchidwellness.com/policies/4698920194) ## Orchid Wellness Web App⏎ _Terms of Use_ Orchid Wellness • app.myorchidwellness.com • Effective: June 4, 2025 These Terms of Use govern your access to and use of the Orchid Wellness web app at app.myorchidwellness.com and its related services, operated by Orchid Wellness. By using the web app, you agree to these terms. If you do not agree, please do not use the web app. ### 01 Eligibility You must be at least 13 years old, or the legal age of majority in your jurisdiction, to use this web app. Users under the age of 18 may only use the web app under the supervision of a parent or legal guardian who agrees to be bound by these Terms. ### 02 Medical Disclaimer The Orchid Wellness web 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 web 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 web 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 [info@myorchidwellness.com](https://myorchidwellness.com/policies/info@myorchidwellness.com) 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 web app is subject to our [Web App Privacy Policy](https://myorchidwellness.com/policies/#app-privacy) above. By using the web 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 web app, including the MySWANS ™ framework and name, are the property of Orchid Wellness 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 web app or interfere with its functionality, use the web 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 web app may contain links or integrations with third-party services, including Cherry and OptiMantra. 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 shall not be liable for any indirect, incidental, special, consequential, or punitive damages arising from your use of the web 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 web app or by email when material changes are made. Continued use of the web app following any update constitutes your acceptance of the revised Terms. ### 13 Contact Us Questions About These Terms Orchid Wellness 3620 N Josey Lane, Suite 117 Carrollton, TX 75007 [info@myorchidwellness.com](https://myorchidwellness.com/policies/info@myorchidwellness.com) [(469) 892-0194](https://myorchidwellness.com/policies/4698920194) ## Cancellation _Policy_ Orchid Wellness • 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 at app.myorchidwellness. com 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 at app.myorchidwellness.com. ## Telehealth _Consent_ Required for all telehealth patients • Orchid Wellness Telehealth allows patients to receive clinical care from Chelsea Asante, FNP-C via secure video or phone without an in-person visit. Before receiving telehealth services, patients must acknowledge and consent to the following. ### 01 Scope of Telehealth Services Telehealth services at Orchid Wellness are available to patients physically located in Texas, New York, Virginia, and Washington DC at the time of the visit. Services include primary care consultations, chronic disease management, medication management, hormone therapy follow-ups, and wellness visits appropriate for a virtual format. ### 02 Limitations Telehealth has inherent limitations. Some conditions require an in-person physical exam and cannot be fully assessed via video. If Chelsea determines that an in-person visit is clinically necessary, she will inform you and assist with coordinating appropriate care. ### 03 Privacy and Security Telehealth visits are conducted through HIPAA-compliant, encrypted platforms. You are responsible for ensuring that your environment is private during the visit. You should not conduct telehealth appointments from a public location or shared space where others may overhear confidential health information. ### 04 Patient Rights * You have the right to refuse telehealth services and request in-person care instead * You may withdraw consent for telehealth at any time without affecting your right to future care * You have the right to review all information transmitted during your telehealth visit * You may request that your telehealth records be forwarded to another provider at any time ### 05 Technical Requirements A stable internet connection and a device with a working camera and microphone are required for video telehealth visits. If you experience technical difficulties, please call (469) 892-0194 and we will do our best to complete the visit by phone or reschedule at no charge. ## Payment _Policy_ Orchid Wellness • 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 **[info@myorchidwellness.com](https://myorchidwellness.com/policies/info@myorchidwellness.com)** 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](https://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](https://myorchidwellness.com/memberships/) 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. Still Have Questions? We are happy to _help._ [Patient Portal](https://www.optimantra.com/optimus/om/patient/login?accessPoint=VzVOMm00cHQxOXpOYVRlWjUzZUlYQT09) [Call (469) 892-0194](https://myorchidwellness.com/policies/4698920194)