Legal Forms & Member Information
Review our membership agreements, privacy policies, and consent forms before joining.
Membership Agreements
Core Membership Agreement PDF
The foundation of our direct primary care relationship. Explains what's included in membership, your responsibilities, and practice policies.
View Agreement →Financial Terms & Payment PDF
Details on membership fees, payment methods, family caps, additional service costs, and billing policies.
View Terms →House Call Services PDF
Agreement for house call services including geographic area, fees, safety requirements, and what to expect.
View Agreement →Privacy & Legal Documents
HIPAA Notice of Privacy Practices PDF
Federally required notice explaining how we protect your child's health information and your privacy rights.
View Notice →Privacy Policy Webpage
How we collect, use, and protect your information on our website and digital platforms.
View Policy →Website Disclaimer Webpage
Legal disclaimers about medical information on our website and limitations of online advice.
View Disclaimer →Consent Forms (Provided at Enrollment)
Telehealth Consent PDF
Authorization for virtual care via phone, video, text, and email. Explains benefits, limitations, and privacy.
View Consent →General Consent for Treatment PDF
Broad consent for medical care, exams, procedures, medications, and other pediatric services.
View Consent →Photo/Video Consent PDF
Optional authorization to use photos, videos, or testimonials for marketing and educational purposes.
View Consent →Procedure-Specific Informed Consents
These forms are provided when scheduling the specific procedure.
Newborn Circumcision PDF
Comprehensive consent for circumcision including methods, risks, benefits, pain management, and aftercare.
View Consent →Medical Ear Piercing PDF
Informed consent for medical-grade ear piercing using Blomdahl system, including risks and aftercare.
View Consent →Learn More About Our Services
Educational resources about the specialized services we offer to our members.
House Calls: A Rare Privilege Webpage
Why house calls are special and how they work at our practice, including boundaries and expectations.
Learn More →Medical-Grade Ear Piercing Webpage
Why medical-grade piercing is different from mall piercing and what to expect from the Blomdahl system.
Learn More →Newborn Circumcision Webpage
Medical benefits, techniques, and what to expect from this common newborn procedure.
Learn More →What to Expect When You Enroll
- You'll sign the Core Membership Agreement, Financial Terms, and House Call Services Agreement
- You'll receive and acknowledge the HIPAA Notice of Privacy Practices
- You'll sign consent forms for Telehealth and General Treatment
- Photo/Video consent is optional—you can decline and still be a member
- Procedure-specific consents (circumcision, ear piercing) are signed only if you choose those services
Additional Consents During Care
- Some procedures require separate informed consent at the time of service
- You'll always have the opportunity to ask questions before signing
- You can request copies of any signed documents at any time
Questions About Our Documents?
We're happy to discuss any of these documents with you before you enroll.
Email us at info@wholepeds.com or call 909-553-5279 (text only)