Updated: May 25th, 2026
Health Care Authorization (HIPAA)
I have been provided with a copy of the Notice of Privacy Practices for Protected Health Information. The Notice of Privacy Practices describes the types of uses and disclosures of my Protected Health Information (PHI) that will occur in my treatment, payment of my bills or in the performance of health care operations of this chiropractic office. A copy of our notice is attached and we encourage you to read it and request your own copy if you would like one.
This Notice of Privacy Practices also describes my rights and duties of the Chiropractor with respect to my protected health information. I hereby give permission to Precision Chiropractic to use and/or disclose Protected Health Information in accordance with the following:
Specific Authorizations:
- I give permission to Precision Chiropractic to use my address, phone number and clinical records to contact me with appointment reminders, missed appointment notification, birthday cards, holiday related cards, newsletters, information about treatment alternatives or other health related information.
- If Precision Chiropractic contacts me by phone, I give them permission to leave a phone message on my answering machine or voicemail.
- I give permission to Precision Chiropractic to use any testimonial written by me for marketing purposes such as, sharing with other patients or potential patients, in their brochure, on their website or in ads in print media.
- I give Precision Chiropractic permission to treat me in an open room where other patients are also being treated. I am aware that other persons in the office may overhear some of my protected health information during the course of care. Should I need to speak with doctor at any time in private, the doctor will provide a room for these conversations.
- By signing this form you are giving Precision Chiropractic permission to use and disclose your protected health information in accordance with the directives listed above.
The use of this format is intended to make your experience with our office more efficient and productive as well as to enhance your access to quality health care and health information. This authorization will remain in effect for the duration of my care at Precision Chiropractic plus 7 years or until revoked by me.
Right to Revoke Authorizations:
You have the right to revoke this AUTHORIZATION, in writing, at any time. However, your written request to revoke this AUTHORIZATION is not effective to the extent that we have provided services or taken action in reliance on your authorization.
You may revoke this AUTHORIZATION by mailing or hand delivering a written notice to the Privacy Official of Precision Chiropractic. The written notice must contain the following information:
- Your name, social security number and date of birth;
- A clear statement of your intent to revoke this AUTHORIZATION;
- The date of your request; and your signature.
The revocation is not effective until it is received by the Privacy Official.
This AUTHORIZATION is requested by Precision Chiropractic for its own use/disclosure of PHI. (Minimum necessary standards apply.)
I have the right to refuse to sign this AUTHORIZATION. If I refuse to sign this AUTHORIZATION, Precision Chiropractic will not refuse to provide treatment, however, it will not be possible for Precision Chiropractic to file third party billing on my behalf and I will be responsible for:
- Payment in full at the time services are provided to me.
- Scheduling my own appointments since Precision Chiropractic will be unable to contact me.
- All contact with Precision Chiropractic regarding my care.
- Additionally, any collection activity as permitted by law is not waived by refusal to sign the authorization.
I have the right to inspect or copy, within boundaries, the protected health information to be used/disclosed. A reasonable fee for copying will apply. A copy of the signed authorization will be provided to me.
Healthcare Authorization
I have read and understand this Healthcare Authorization Form and acknowledge receipt of The Notice of Privacy Practices for Protected Health Information. My agreement below is in lieu of my signature and represents an agreement with these practices.
Communication and SMS Messaging Terms
At Precision Chiropractic, we are committed to protecting the privacy and confidentiality of your personal information. This Communication Privacy Policy outlines how we collect, use, disclose, and safeguard your communication-related data. By engaging with our services, you agree to the terms outlined in this policy.
1. Information We Collect
- Contact Information: We may collect your name, email address, phone number, and other contact details when you communicate with us.
- Communication Content: We may collect information related to your communication with us, including emails, messages, and other forms of communication.
2. How We Use Your Information
- Communication Processing: We use your contact information to communicate with you and respond to your inquiries, requests, or concerns.
- Service-related Communications: We may send you service-related announcements, updates, and administrative messages.
- Improving Services: Your communication data may be used to analyze trends, track user interactions, and improve our services.
3. Information Sharing and Disclosure
- Third-Party Service Providers: We may engage third-party service providers to assist with communication services. These providers are contractually obligated to maintain the confidentiality and security of your information and may only use it as permitted by our agreements with them.
- Legal Requirements: We may disclose your information if required by law, regulation, or legal process.
4. Security Measures
- Data Security: We implement reasonable security measures designed to protect against unauthorized access, disclosure, alteration, or destruction of your information.
5. Your Choices
- Opting Out: You may choose not to receive non-essential communications from us by following the opt-out instructions included in the communication or by contacting us directly.
6. Information Protection
- No Sale or Distribution: Your information will not be sold or distributed to third parties for their own marketing purposes.
7. Contact Information
If you have any questions about this Communication Privacy Policy or our practices, please contact us at:
Precision Chiropractic
300 Cornerstone Dr, Ste 215
Williston, VT 05495
Email: drandrew@precisionchirovt.com
Phone: (802) 557-0527
SMS Messaging Terms & Conditions
At Precision Chiropractic, you can choose to opt in to receive text message (SMS) notifications.
About These Notifications
- Notifications may include appointment reminders, schedule updates, and other information related to the services provided by Precision Chiropractic.
- Messaging frequency varies based on your interaction with our office and the services you receive.
- Standard message and data rates may apply according to your mobile carrier plan.
Consent to Receive SMS Messages
- By providing your mobile phone number and opting in (for example, through a form, checkbox, or other documented consent mechanism), you consent to receive SMS messages from Precision Chiropractic at the number you provide.
- Your consent to receive SMS messages is not a condition of receiving treatment or services, and you may still receive care if you choose not to opt in to SMS messaging.
Opt-Out Instructions
- You may opt out of receiving SMS messages at any time by replying STOP to any message you receive from us.
- After you send STOP, we may send you a confirmation message to verify that you have been unsubscribed. Once confirmed, you will no longer receive SMS messages from us at that number, except as required or permitted by law.
- You may also opt out by contacting Precision Chiropractic directly using the contact information provided above and requesting that SMS communications be disabled for your number.
Help Information
- If you need assistance regarding SMS messages, you can reply HELP (or OPTIONS) to any message you receive from us to receive additional information about the program.
- You may also contact us using the email or phone number listed in the Contact Information section for further help.
Privacy and Use of Information for SMS
- Your mobile phone number and any information associated with SMS messaging will be used in accordance with this Communication Privacy Policy and our overall privacy practices.
- Your information will not be sold or distributed to any third party for their own marketing or promotional purposes.
- Third-party vendors that facilitate our SMS messaging act as service providers and are required to protect your information and use it only as permitted by our agreements with them.
By opting in to receive SMS notifications, you acknowledge that you have read and understand these SMS Messaging Terms & Conditions and agree to receive messages as described above. You may withdraw your consent at any time by following the opt-out instructions.
Cookies and Tracking Technologies
This section explains how Precision Chiropractic uses cookies, pixels, scripts, embedded content, and similar technologies on this website. These technologies may help the website function properly, remember cookie preferences, measure website performance, understand general website usage, support embedded content, and operate certain third-party services.
This Cookie section applies only to website activity. It does not replace or modify the Health Care Authorization (HIPAA) section or the Communication and SMS Messaging Terms listed above.
What Are Cookies and Similar Technologies?
Cookies are small text files placed on your device when you visit a website. Cookies may help a website remember preferences, support basic functionality, measure website performance, or allow third-party services to work properly.
Similar technologies may include pixels, tags, scripts, embedded media, local storage, browser identifiers, device identifiers, and other tools that collect or store information about your interaction with a website.
Types of Cookies and Tracking Technologies We May Use
Precision Chiropractic may use the following types of cookies and tracking technologies:
- Essential Cookies: These cookies are necessary for the website to function properly. They may support basic website features such as security, page navigation, form functionality, spam prevention, and remembering your cookie consent preferences. Essential cookies may be active by default because the website may not work properly without them.
- Preference Cookies: These cookies may remember choices you make on the website, such as cookie consent settings or other display preferences.
- Analytics and Performance Cookies: These cookies help us understand general website usage, such as page views, traffic sources, browser type, device type, approximate location, and how visitors move through the site. This information is used to evaluate website performance, improve content, and improve the user experience.
- Marketing and Advertising Cookies: Precision Chiropractic is not currently using website cookies for active advertising campaigns, but may use advertising tools in the future. The website currently includes the Meta/Facebook Pixel, which may be used for website measurement, audience insights, ad performance measurement, or future advertising activity. These tools may be provided by third-party platforms such as Meta/Facebook or Google.
- Embedded Content and Third-Party Service Cookies: Some pages may include embedded content or third-party tools, such as YouTube videos, Google Forms, Google Maps, Google reviews, newsletter signup forms, scheduling tools, security tools, or other external services. These third parties may use cookies, pixels, scripts, or similar technologies when you view or interact with their content.
- Unknown or Unclassified Cookies: From time to time, new cookies may appear on the website as third-party services are updated or new website features are added. We periodically review cookies and tracking technologies used on the website and may update our cookie settings or this Privacy Policy section as needed.
Google Analytics and Website Performance
Precision Chiropractic uses Google Analytics to understand general website usage and performance. Google Analytics may use cookies, identifiers, and similar technologies to collect information such as pages visited, traffic sources, browser and device information, approximate location, and interactions with website content.
This information is used to evaluate website traffic, improve website content, improve navigation, and understand how visitors use the website. Precision Chiropractic uses Google Analytics for website performance and usage analysis, not to collect information submitted through embedded Google Forms.
Google may process Analytics information according to its own privacy policies and terms. Precision Chiropractic does not control how Google processes information collected through Google Analytics or related Google services.
You can learn more about how Google uses information from websites that use its services here:
https://policies.google.com/privacy/partners
You can learn more about Google's use of cookies here:
https://policies.google.com/technologies/cookies
You can learn more about Google's privacy practices here:
https://policies.google.com/privacy
Embedded Google Forms
Some pages on this website may include embedded Google Forms. These forms are provided through Google services and may appear within the website as embedded iframe content.
When you complete and submit an embedded Google Form, the information you provide is submitted through Google and stored in Precision Chiropractic's Google Workspace account. Precision Chiropractic uses Google Workspace for these forms and maintains appropriate agreements with Google for handling information submitted through those services.
Google Forms and related Google services may use cookies, scripts, or similar technologies when a form is displayed or submitted. Your interaction with embedded Google Forms may also be subject to Google's privacy policies and terms.
Contact and Newsletter Forms
This website may include contact forms or newsletter signup forms. If you choose to submit one of these forms, Precision Chiropractic may collect the information you provide, such as your name, email address, phone number, message, or newsletter signup preference.
Newsletter signup information is used to send newsletter or educational communications. You may unsubscribe from newsletter communications by using the unsubscribe option included in the message or by contacting Precision Chiropractic directly.
Meta/Facebook Pixel
Precision Chiropractic uses the Meta/Facebook Pixel. This tool may allow Meta/Facebook to collect information about your visit to this website, including browser or device information, pages viewed, actions taken on the website, referral information, and interactions with website content.
Precision Chiropractic is not currently running active advertising campaigns through this website, but the Meta/Facebook Pixel may support website measurement, audience insights, ad performance measurement, or future advertising activity.
Meta/Facebook may process information collected through the Pixel according to its own privacy policies and terms. Precision Chiropractic does not control how Meta/Facebook processes information collected through Meta technologies.
You can learn more about Meta's use of cookies here:
https://www.facebook.com/privacy/policies/cookies/
You can learn more about Meta's privacy practices here:
https://www.facebook.com/privacy/policy/
YouTube Videos and Embedded Media
Precision Chiropractic may include embedded YouTube videos or other third-party media on this website. Embedded content from YouTube or other third-party services may behave as if you visited those third-party websites directly.
YouTube is operated by Google. When you view or interact with embedded YouTube content, Google/YouTube may collect information such as browser or device information, IP address, video interactions, watch behavior, and other technical data. Google/YouTube may also use cookies or similar technologies according to its own privacy policies.
Where possible, embedded videos may be configured to use privacy-enhanced options or may be blocked until you consent to the relevant cookie or embedded content category.
Future Advertising and Remarketing
Precision Chiropractic may use advertising services in the future, including Google Ads, Meta/Facebook Ads, or similar platforms.
If advertising or remarketing tools are used, they may use cookies, pixels, scripts, or similar technologies to measure ad performance, understand general website activity, create advertising audiences, limit repeated ads, or show more relevant advertising on third-party platforms.
No Sale of Personal Information by Precision Chiropractic
Precision Chiropractic does not sell your personal information.
However, third-party services used on this website, including Google, Meta/Facebook, YouTube, analytics tools, embedded form providers, newsletter tools, advertising platforms, embedded media providers, and other external services, may collect and process information through cookies, pixels, scripts, embedded content, or similar technologies according to their own privacy policies and terms.
Your use of this website may therefore involve interactions with third-party services that are not owned or controlled by Precision Chiropractic.
Cookie Consent and Preference Management
When you visit this website, you may be presented with a cookie consent notice that allows you to accept, reject, or manage certain categories of cookies and tracking technologies.
You may be able to choose whether to allow categories such as analytics cookies, marketing cookies, preference cookies, or embedded content cookies. Essential cookies may be required for the website to function and may not be disabled through the website's cookie settings.
The website may store a record of your cookie consent preferences, including the categories accepted or rejected, the date of consent, and a consent identifier. This helps the website remember your choices and document consent preferences.
You may change your cookie preferences at any time by reopening the cookie settings or consent preferences tool available on the website.
Browser Controls
You may also control or delete cookies through your browser settings. Most browsers allow you to block cookies, delete existing cookies, or receive alerts when cookies are being used.
If you block or delete cookies, some parts of the website may not function properly, and your cookie consent preferences may need to be selected again.
Third-Party Websites and Services
This website may contain links to third-party websites or embedded content from third-party services. Precision Chiropractic does not control the cookies, tracking technologies, privacy practices, content, or security practices of third-party websites or services.
Your interaction with third-party websites, platforms, embedded content, forms, or external services is governed by the privacy policies and terms of those third parties.
Changes to Cookie Practices
Precision Chiropractic may update this Cookie section from time to time to reflect changes in website functionality, third-party services, legal requirements, advertising practices, analytics tools, or business operations.
Any updates will be posted on this Privacy Policy page. Your continued use of the website after updates are posted means you accept the revised Cookie section.
Contact Information
If you have questions about this Cookie section or our privacy practices, please contact us:
Precision Chiropractic
300 Cornerstone Dr, Suite 215
Williston, VT 05495
Phone: (802) 557-0527
Email: drandrew@precisionchirovt.com