NOTICE OF PRIVACY PRACTICES

Effective Date: 12/30/2025
Last Updated: 12/30/2025

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice provides an overview of the basic rights and responsibilities for clients of Realign Myo Therapy, LLC (“we,” “our”, or “us”), outlines the general expectations of our practice, and describes how Realign Myo Therapy, LLC manages your health information. Please note that it is not a comprehensive description of all rights and responsibilities.

YOUR RIGHTS

You have certain rights when it comes to your health information. You have the right to:

1. GET AN ELECTRONIC OR PAPER COPY OF YOUR CLIENT RECORD. You can ask to see or get a copy of your client record and other health information that we have about you. Most client records are available for free through Realign Myo Therapy’s client portal. We may charge a reasonable, cost-based fee as allowed by law. In limited circumstances, Realign Myo Therapy may determine that some portions of a client’s file may not be available such as information compiled in anticipation of, or for use in, civil, criminal, or administrative proceedings. If any part of your record cannot be shared, you will receive a written explanation in accordance with HIPAA regulations.

2. ASK US TO CORRECT YOUR CLIENT RECORD. You may ask us to correct your client record or health information about you that you think is incorrect or incomplete. Please submit a written request to info@realignmyo.com. We may say “no” to your request, but we’ll tell you why in writing within 60 days

3. RIGHT TO ASK US TO LIMIT WHAT WE USE OR SHARE. You may ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

4. RIGHT TO A COPY OF OUR PRIVACY NOTICE. You may request a copy of our privacy notice. You can ask for a paper copy of such notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. If you choose to request a copy, please submit a written request to info@realignmyo.com.

5. RIGHT TO REQUEST COMMUNICATIONS BE SENT TO AN ALTERNATIVE LOCATION OR BY AN ALTERNATIVE MEANS. You can request that communications be sent to alternative locations or by alternative means to further protect your privacy. We will say “yes” to all reasonable requests.

6. RIGHT TO CHOOSE SOMEONE TO ACT FOR YOU. You may choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your client rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action. We will require a copy of your notarized Power of Attorney document to be on file

7. RIGHT TO FILE A COMPLAINT IF YOU FEEL YOUR RIGHTS ARE BEING VIOLATED. You may file a complaint if you feel your rights are violated. You can submit a complaint if you feel we have violated your rights by contacting us at info@realignmyo.com. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html. We will not retaliate against you for filing a complaint.

YOUR RESPONSIBILITIES

You have the responsibility to:

1. COMPLETE A WRITTEN REQUEST TO RELEASE INFORMATION. If you would like us to share information with, or request information from, another individual or organization, please complete and submit our Release of Information Form.

2. PAY CLIENT’S SHARE OF SERVICES. Payment is due in full at the time of service or in advance according to the agreed-upon therapy package or plan. All fees are nonrefundable, including for missed sessions or early withdrawal from therapy.

3. NOTIFY OUR OFFICE IN ADVANCE OF MISSING AN APPOINTMENT. A minimum of 24 hours' notice is required for cancellation or rescheduling. Cancellations with less than 24 hours’ notice or “no-shows” will result in a loss of a prepaid session or current price of a full session. Repeated missed or late appointments may result in dismissal from the therapy program or an agreed upon pause of the program to resume at a specified future time.

OUR RESPONSIBILITIES

Realign Myo Therapy is required by law to maintain the privacy and security of your protected health information (“PHI”) and to provide you with notice of our legal duties and privacy practices. We do not sell your health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html.

OUR USES AND DISCLOSURES

Realign Myo Therapy may use and share your information as we coach you, run our practice, bill for your services, help with public health and safety issues, comply with the law, address workers’ compensation, law enforcement, and other government requests, and respond to lawsuits and legal actions.

We typically use or share your health information in the following ways:

• To coach you. We can use your health information and share it with other professionals who are treating you. Example: A provider treating you for an injury asks another provider about your overall health condition.

• To run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

We are allowed or required to share your information in other ways such as in ways that contribute to the public good, such as public health and research. We have to meet certain conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. We may use or share your health information in the following ways:

• To Help with public health and safety issues. We can share health information about you for certain situations such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and/or preventing or reducing a serious threat to anyone's health or safety.

• To do research. We can use or share your information for health research.

• To comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.

• To work with a medical examiner or funeral director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

• To address workers’ compensation, law enforcement, and other government requests. We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and/or for special government functions such as military, national security, and presidential protective services.

• To respond to lawsuits and legal actions. We can share health information about you in response to a court or administrative order, or in response to a subpoena.

USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Certain uses and disclosures of your health information require your written authorization. These include:

• Use or disclosure of your information for marketing purposes not involving face-to-face communication or promotional gifts;

• Any other uses or disclosures of your health information not described in this notice.

If you authorize Realign Myo Therapy to use or disclose your health information, you may revoke that authorization at any time, in writing, except to the extent that we have already taken action based on your authorization.

CHANGES TO THE TERMS OF THIS NOTICE

Realign Myo Therapy can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

CONTACT INFORMATION

Realign Myo Therapy, LLC
Email: info@realignmyo.com

Address: Colorado Springs, CO 80925

Phone: (719) 413-9929