Patient Forms and Terms & Conditions

You may print the forms below and bring them into the clinic with you or fill them out online via our Klara messaging system. Choose the option that best suits you.

Language Services

https://www.priviahealth.com/notice-nondiscrimination/

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Release of Patient Information

HIPPA Authorization to Release Patient Information

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Consent to Treatment

Authorization and Consent to Treatment

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Preferred Contact

Preferred communication and contact form.

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Privacy Practice

Notice of Privacy Practices.

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Financial Policy

Financial policy and patient responsibility.

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SMS Consent & Disclosure Policy:

By providing your mobile number, you agree to receive text messages from Tinovus Health regarding your healthcare. These messages may include:

Appointment reminders and confirmations
Billing notifications and payment reminders
Important health-related updates
Post-visit survey reminders
2FA

Message Frequency: You may receive multiple messages depending on your appointments and account activity.

Message & Data Rates: Standard message and data rates may apply based on your mobile carrier’s plan.

Privacy Policy: For details on how we protect your information, please review our Privacy Policy here: https://www.tinovushealth.com/_files/ugd/41e786_833847f009ac4b559525086015088082.pdf

Help & Support: If you need assistance, reply with “HELP” for more information.

Opt-Out: You can stop receiving text messages at any time by replying with “STOP” to unsubscribe from all future messages.

For any questions, please contact us by phone at 254-253-2855 or visit our website tinovushealth.com