Telehealth visits from the comfort of your home · IBCLC-certified · Board-Certified Pediatrician
Patient Resources & Required Disclosures
Important information and forms for your telehealth visit. All documents available in English and Spanish.
What You Need to Know Before Your First Visit
At MindMilkMD, we believe in transparency and informed consent. Before your telehealth visit, we provide all necessary forms, privacy policies, and regulatory information so you know exactly what to expect.
Below you’ll find all the documents you need to review and download. Please take time to read through these materials — they’re important for your safety and privacy.
Below you’ll find all the documents you need to review and download. Please take time to read through these materials — they’re important for your safety and privacy.
CONSENT & AUTHORIZATION
Authorization and Consent (English)
Standard consent form for telehealth services and medical care.
Source: CALTRC Sample Template
Authorization and Consent (Spanish)
Formulario de autorización y consentimiento para servicios de telemedicina
Plantilla de Ejemplo de CALTRC
TELEHEALTH INTAKE & REGULATORY DISCLOSURE
Telehealth Regulatory Intake and Disclosure Package (English)
Comprehensive disclosure package covering telehealth policies, risks, and regulatory information
Telehealth Regulatory Intake and Disclosure Package (Spanish)
Paquete integral de divulgación regulatoria de telemedicina (en español)
ACCESSIBILITY & ACCOMMODATIONS
Telehealth Accessibility & Accommodations Statement
Our commitment to accessible telehealth care and how to request accommodations
PRIVACY & HIPAA RIGHTS
Your Rights Under HIPAA
Information about your privacy rights under the Health Insurance Portability and Accountability Act (HIPAA)
U.S. Department of Health & Human Services
Milk & Mind Privacy Policy
Our complete privacy policy and how we protect your personal and medical information
U.S. Department of Health & Human Services