HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use and disclose your protected health information for purposes related to:

Treatment

We may use your health information to provide chiropractic care, therapies, rehabilitation services, referrals, imaging recommendations, treatment planning, and coordination of care with other healthcare providers.

Payment

As a self-pay office, we may use your information to:

Process payments

Maintain payment records

Provide superbills

Communicate regarding balances, memberships, or payment arrangements

Healthcare Operations

We may use your information for:

Internal office administration

Quality improvement

Staff training

Scheduling and appointment reminders

Compliance and legal obligations

ELECTRONIC COMMUNICATIONS

By providing your phone number and/or email address, you consent to receive communications from Dr. Dan’s Organic Health Club regarding:

Appointment reminders

Scheduling

Billing

Treatment follow-up

Office updates

Wellness reminders

Communications may occur via:

Phone calls

Voicemail

SMS/text messaging

Email

Please note that electronic communications may not always be fully secure. Standard message and data rates may apply. You may opt out of non-essential communications at any time by notifying our office. Reply STOP to end further communication. Must reply START to begin again.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the right to:

Request access to your records

Request amendments to your records

Request restrictions on certain disclosures

Request confidential communications

Obtain a copy of this Notice

Receive an accounting of certain disclosures

Requests must be submitted in writing when required by law.

MEDIA, SECURITY & OFFICE MONITORING

For safety, security, and operational purposes, portions of the office may utilize audio and video monitoring.

Any recordings are confidential and maintained securely.

No patient photographs, videos, or testimonials will be used for marketing or educational purposes without patient permission.

Patients may notify the office if they do not wish to participate in any optional media or marketing content.

INFORMED CONSENT TO CARE

By receiving treatment at Dr. Dan’s Organic Health Club, you voluntarily consent to chiropractic evaluation and treatment, including but not limited to:

Chiropractic adjustments/manipulation

Manual therapies

Soft tissue therapies

Instrument-assisted therapies

Spinal decompression

Laser therapy

Red light therapy

PEMF/HEIT therapies

Shockwave therapy

Rehabilitative and corrective exercises

Stretching and mobility therapies

NO GUARANTEE OF RESULTS

I understand that chiropractic and therapeutic care are not exact sciences and that no guarantees or promises regarding results or improvement have been made.

Individual response to treatment varies and outcomes may depend on factors including:

Severity and chronicity of symptoms

Underlying conditions

Lifestyle factors

Compliance with recommendations

Physical activity and stress levels

Overall health status

RISKS & POSSIBLE REACTIONS

I understand that risks associated with chiropractic and therapeutic treatment may include, but are not limited to:

Temporary soreness or stiffness

Muscle spasm

Swelling or tenderness in treated areas

Headache

Fatigue following treatment

Dizziness or lightheadedness

Aggravation or temporary worsening of symptoms

Delayed onset soreness similar to post-exercise discomfort

Rare but serious complications

I understand that some symptoms may temporarily worsen before improvement occurs.

I voluntarily assume the known and inherent risks associated with chiropractic and therapeutic care.

PREGNANCY ACKNOWLEDGMENT

Patients are responsible for informing the office if they are pregnant or believe they may be pregnant so treatment and therapies may be appropriately modified.

REFERRALS & MEDICAL RECOMMENDATIONS

If the office recommends additional medical evaluation, specialist consultation, imaging, or diagnostic testing and the patient chooses not to proceed, the patient accepts responsibility for that decision.

EMERGENCY AUTHORIZATION

In the event of a medical emergency during a visit, including fainting, unexpected reaction, or other urgent condition, the office may contact emergency services if deemed necessary.

FINANCIAL POLICY

Dr. Dan’s Organic Health Club is a self-pay practice and does not directly bill insurance.

Patients may request a superbill for possible reimbursement through out-of-network insurance benefits.

Patients understand and agree that:

Payment is due at the time of service unless otherwise arranged.

The office may maintain a valid payment method on file.

Cards on file may be charged for services rendered, memberships, packages, recurring wellness plans, missed appointment fees, and outstanding balances in accordance with office policies.

Memberships and recurring wellness plans may include automatic recurring billing according to the agreed-upon membership terms.

HSA/FSA cards are accepted.

CANCELLATION & MISSED APPOINTMENT POLICY

We respectfully request advance notice for appointment cancellations or rescheduling.

Missed appointments or late cancellations may be subject to fees at the discretion of the office.

MEMBERSHIP TERMS

Membership terms, pricing, credits, billing cycles, freezes, cancellations, and expiration policies are subject to the agreement signed at enrollment.

Unused credits may expire according to membership terms.

RELEASE OF LIABILITY

Patients acknowledge and accept the inherent risks associated with chiropractic and therapeutic services.

To the fullest extent permitted by law, Dr. Dan’s Organic Health Club and its providers shall not be held responsible for ordinary known risks or reactions associated with care, except in cases of gross negligence or willful misconduct