YOUR PRIVACY MATTERS

Talia Wellness & Spa is committed to protecting the privacy and confidentiality of your health information. This Notice explains how your medical information may be used and disclosed, your rights regarding your health information, and our responsibilities under the Health Insurance Portability and Accountability Act (HIPAA).

OUR COMMITMENT TO YOU

We are required to:

• Protect the confidentiality of your health information.
• Provide you with this Notice of Privacy Practices.
• Follow the terms outlined in this notice.
• Notify you if a breach of unsecured protected health information occurs.
• Obtain your authorization when required by law before disclosing information for non-permitted purposes.

HOW WE MAY USE AND DISCLOSE YOUR INFORMATION

Talia Wellness & Spa may use or disclose your health information without additional authorization for:

Treatment

To provide, coordinate, and manage your care and wellness services, including communication with physicians, nurse practitioners, laboratories, pharmacies, and other healthcare providers involved in your treatment.

Payment

To obtain payment for rendered services, verify insurance benefits, process claims, collect balances, and perform billing-related activities.

Healthcare Operations

For quality improvement, accreditation, training, compliance, auditing, credentialing, business planning, patient safety initiatives, and operational management activities.

Additional Permitted Disclosures

When required or permitted by law, including:

• Public health reporting.
• Health oversight activities.
• Law enforcement requests.
• Court orders.
• Emergency situations.
• Prevention of serious threats to health or safety.

PATIENT RIGHTS

Access Your Records

Request a copy of your medical or wellness records in paper or electronic format.

Request Corrections

Ask us to amend information you believe is incomplete or inaccurate.

Request Confidential Communications

Request that we contact you at a specific phone number, email address, or mailing address.

Request Restrictions

Request limitations on certain uses or disclosures of your information. While we may not always be able to accommodate every request, we will review each request individually.

Receive an Accounting of Disclosures

Request a record of certain disclosures made outside of treatment, payment, and healthcare operations.

Designate a Representative

Authorize another individual to make healthcare decisions or access information on your behalf when legally permitted.

File a Complaint

You may file a complaint without fear of retaliation if you believe your privacy rights have been violated.

CONSENT FOR TREATMENT AND SERVICES

By signing below, you acknowledge and consent to:

Wellness Services

• Medical weight management.
• Peptide therapy.
• IV hydration therapy.
• Hormone optimization consultations.
• Nutritional counseling.
• Wellness assessments.

Aesthetic Services

• Botox® and neurotoxin treatments.
• Dermal fillers.
• Chemical peels.
• HydraFacial® treatments.
• Microdermabrasion.
• Skin rejuvenation procedures.

Treatment Acknowledgment

You understand that:

• Treatment outcomes cannot be guaranteed.
• Risks, benefits, alternatives, and expected outcomes will be discussed before treatment.
• You have the right to refuse or discontinue treatment at any time.
• Refusing treatment may impact desired outcomes.

PHOTOGRAPHY AND MARKETING AUTHORIZATION

Clinical photographs may be taken for:

• Medical documentation.
• Treatment planning.
• Progress tracking.

Separate written authorization will be obtained before any identifiable photographs are used for marketing, advertising, social media, website content, testimonials, or promotional materials. HIPAA generally requires authorization for uses beyond treatment, payment, and healthcare operations.

TEXT, EMAIL, AND APPOINTMENT COMMUNICATIONS

By providing contact information, you consent to receive:

• Appointment reminders.
• Treatment follow-up communications.
• Billing notifications.
• Wellness program information.

You may opt out of non-essential communications at any time.

PAYMENT POLICY

Patients are responsible for:

• Payment of services rendered.

Payment is due at the time services are rendered unless other arrangements have been approved.

QUESTIONS OR PRIVACY CONCERNS