Dental Integration of a Postural Restoration-based Physical Therapy Program with a Custom Occlusal Orthotic (Splint)

Purpose of Custom Occlusal Orthotic: 

A custom occlusal orthotic or splint formed by your dentist assists in the positioning of your head and neck. One of the most important senses we have in our bodies is how our teeth contact each other (occlusion), and this contact (bite) can have drastic effects on how we position our bodies against gravity. Our brain receives input (i.e. “feel”) from our teeth, ligaments of the teeth, mechanical position of the jawbone (mandible), and temporomandibular joints (TMJ), and this input results in how our head, neck, and bite are positioned. These positions can be less than ideal, and receiving a custom occlusal orthotic can assist in having an ideal bite and, therefore, help to maintain a proper resting position of the head, neck, and body (i.e., “neutral”) against gravity.  

How a Custom Occlusal Orthotic Works: 

The orthotic splint is designed by the dentist and therapist to give you uniform molar contact on both sides while your neck is in a neutral state. If there is too much input through the anterior (front) teeth, then this can result in positioning of the head forward, an extended neck posture, and shifting of weight forward onto the balls of the feet, which is not an ideal position for our bodies. Giving proper sensory input to the molars with the splint provides your brain with a consistent, appropriate sense of where your head and neck should be positioned in a neutral state. Having molar contact allows your head to have a reference (i.e., “floor”), and your brain will position the head based on that floor.  When that floor is not positioned properly, your head and neck position will be imbalanced. Using the splint, your molar feel will help to create a level floor and, therefore, allow for proper positioning of the head and neck. This will also have a trickle-down effect on the rest of the body to allow you, as the patient, to feel the actual floor through the heels properly.

In addition, the smooth, flat surface of the splint will allow better movement of the mandible, a more optimal bite, and reduce the inaccurate feel from your normal bite without the custom orthotic. This splint has what are called built-in canine guidance ramps, similar to guardrails, on either side to allow for the jaw to come back to a neutral resting position and give your brain a sense of where the jaw is positioned in space when moving the jaw side to side.   Molar contact in general is utilized by your brain as a ”floor” to rest your head upon. If that “floor” is not in an appropriate position your head position and neck position may be imbalanced. This posterior sense will be integrated with an appropriate sense of the floor under your heels for further upright integration and postural control. The smooth, flat surface of the splint will also “free up” the mandible and occlusion to reduce both the neurological and mechanical influences of the bite position. The occlusal appliance has built into it canine guidance rams on either side to give you appropriate references when moving your jaw from side to side. For example, if you move your jaw to the right, your right canine will come in contact with the splint to dis-occlude the teeth on the left and vice-versa. This way no matter where you position your jaw you will have a reference point to bring you back to a neutral state or position.

Getting your body, and specifically your neck, in a neutral position at the time of fitting the splint is important and will be monitored by your dentist and/or physical therapist. There are test indicators that allow us as providers to measure neutrality and to make sure your splint is designed correctly. At the time of the bite registration and equilibration of the appliance, the correct position of the neck will be assured by your physical therapist (PT) or dentist, using whatever other tools are needed (shoes, glasses, etc.), to make sure the correct position is calibrated into your appliance.

When to Wear Your Custom ApplianceOcclusal Orthotic: 

It is our professional advice that your custom occlusal orthotic be worn at night indefinitely, with any physical therapy exercises and any physical activity. We also encourage, early on in treatment, you to wear your splint as much as possible during the day to allow for your nervous system to learn a new body position and eventually reduce the need for your splint. Your dentist and physical therapist will guide you on when your splint will be worn and if any other aids, such as glasses, foot orthotics, and shoes, need to be worn with your occlusal orthotic. For those patients who have significant breathing dysfunction or bruxism (i.e., “clenching/grinding of teeth”) during sleep, alternative nighttime intervention may be needed, and the splint would be day use only. Typically, we encourage more use of the splint during the daytime even when when not doing your activities, and hope that gradually you will need the splint just for night times. Your PT or dentist will assist you with specifics for your use of this appliance including when to wear it, what to do with it in, and what else to wear with it (i.e. glasses, shoes, orthotics). 

Information on What to do with the Appliance Custom Occlusal Orthotic In: 

It is recommended that you get a custom occlusal orthotic because your head and neck are not positioned properly in a resting state. This usually presents as tension, pain, and decreased mobility. Other signs and symptoms include improper use of certain muscle groups, over- or underuse of muscles, posture abnormalities, and limitations in movement. Once the splint is in place and adjusted to fit you, the patient, normal daily and recreational activity is encouraged because interference from the old bite does not affect the position. Typically, if you are recommended to have an occlusal appliance fabricated, your neck and head have not been assuming an appropriate rest position, which typically manifests itself as tension and/or lack of mobility. Movement of the jaw, head, and neck independent of each other becomes challenged. This can lead to muscle misuse, overuse, or underuse due to positional and structural limitations. Once the splint is in place and calibrated to ensure head and neck neutral positioning, activity is then encouraged to move the head, neck, and jaw independently of each other without interference from the old bite position or pattern.

At rest the jaw is typically open with the teeth not touching, the habitual touching of teeth occurs with swallowing, speech, and movement. We would encourage a resting tongue position where the tip of the tongue rests lightly on the hard palate behind the upper front teeth and a small space is present between the upper teeth and the splint. The splint is not intended to be clenched on, if you are noticing persistent clenching please alert your PT or dentist. 

To Do’s with Custom Occlusal Orthotic InWe Would Encourage:

• It is important to frequently move the jaw to the right and left, sensing the canine “ramp” as the jaw moves from side to side while keeping the tongue resting behind the upper teeth.

•  For example, as the jaw slides to the right, the right canine should hit the ramp and as the tooth slides up the ramp, the left teeth should no longer be in contact with the splint. This sense of either the left or right teeth contacting the splint helps us be aware of where the jaw is positioned and where neutral is and engages the musculature of the jaw in a normal manner (as is needed for efficient and normal speech, chewing, and breathing).

• Periodically throughout your day,  keeping posterior molar contact with the splint, turn your head from side to side in a comfortable range of motion, and swing your arms walking, ensuring your trunk is rotating side to side.

All these things instructions and information in this handout will help retrain your body to move in a more “normal” efficient manner with the neutral starting point pre-set by the tools given to you. You will, probably in most cases, also be given other exercises to encourage neck and trunk movement without interference from your teeth. 

If you have specific questions, please do not hesitate to contact your dentist or physical therapist.

*For more information on the science of Postural Restoration or the Postural Restoration Institute (PRI) from which the concepts and purpose for this splint are designed and developed from, please visit: www.posturalrestoration.com.

Informed Consent for Dental Integration of a Postural Restoration-based Physical Therapy Program with Custom Occlusal Orthotic or Splint 

*Before signing, please be sure to read our educational handout regarding Dental Integration.

RISKS AND LIMITATIONS OF TREATMENT

The ability to have a successful treatment requires collaboration between the dentist, the physical therapist, and the patient. The goal of therapy and the road to healing requires a commitment on the patient’s part to developing preferred movement patterns, being consistent with the exercise program given, and a desire for symptom improvement through proper nutrition and devotion to overall health. We want the best outcome for each patient, and forming a good team is necessary, sometimes requiring additional collaboration with other providers. The advantage of gaining better movement patterns, improving occlusion, oral function, and body neutrality can improve symptoms, but as with any treatment method, there are potential risks and limitations. These risks and limitations are generally low compared to the benefits of moving forward through a treatment program.  If the risks and limitations are of concern, please discuss this with your providers, and alternative treatments can be explored.

There are risks of dental integration with a custom occlusal orthotic (splint), and these include the possibility of headaches, temporomandibular joint pain, speech difficulty, and alteration of bite, along with the potential for further restorative or orthodontic treatment to restore proper occlusion.

To achieve the ideal tooth alignment, there may be a need for an additional phase of treatment, but this all is dependent on the position of teeth prior to treatment, shifting of cranial bones, body position, and ability to clear test indicators done by your physical therapist. Additional treatment could include selective reshaping of teeth to allow for more room in the mouth and improve bite function and stability of the body.  It could also include orthodontic alignment with clear aligners, braces, or surgical intervention such as MSE or MMA.

Patients going through this treatment program may experience temporomandibular joint (TMJ) symptoms before, during, and after treatment. The hope is for these symptoms to be resolved by the end of treatment, although more TMJ therapy may be necessary.

As we go through our lives, we will, over time, naturally fall back into our old movement patterns, and with this, relapse symptoms can occur. The treatments that are part of this program are meant to change posture, habitual habits, and behaviors, but these patterns, in many cases, develop over years to decades, which is why relapse is a concern. Our goal as providers is to give you the tools to succeed in maintaining neutrality and stability, along with keeping symptoms from returning.

TREATMENT TIME, GOALS, AND DISCONTINUANCE OF TREATMENT

The treatment time can vary due to various factors, including, but not limited to, the severity of dysfunction, comorbidities, scheduling limitations, response to treatment, and cooperation of the patient adopting new habits and movement patterns. Other reasons contributing to longer treatment time include missed appointments, poor oral hygiene, lack of facial growth, and broken appliances. All patterns and behaviors take time to change, so we anticipate working together for at least three to four months. However, further follow-ups may be necessary. Throughout the process, there will be test indicators to tell us as providers how your body is positioned, and these indicators can change over time. We aim to have these test indicators all negative by the end of treatment with and without your splint. Success of treatment and discharge will happen when body neutrality is achieved and the ability to maintain proper movement patterns throughout all daily activities.

Treatment will be discontinued for lack of patient cooperation, including poor oral hygiene, missed appointments, lack of wear time of appliances, and in cases where continuing treatment, would unfavorably influence the dental health of the patient. Before treatment is discontinued, the patient or parent will be thoroughly informed of the reasons.

_______________________________________________________________________________________

CONSENT

I understand the inherent risks and benefits of dental integration with custom appliances into my physical therapy program and have been given the time to have my questions addressed. I understand I may require additional treatment.

I, ____________________________________________ (Patient or Parent/Guardian) certify that this informed consent document, outlining the general considerations, as well as the potential problems of dental integration into my physical therapy program, was presented to me, and I have read and understand its contents. I also understand there could be potential risks or problems that could arise that are not listed in this document. I further understand, like any other healing art, that working with the body is at times not an exact science and cannot be guaranteed. I hereby acknowledge that I have been informed of all the treatment considerations, including benefits of treatment, risks of treatment, risks of non-treatment, and the proposed orthodontic/orthopedic treatment plan, and I consent to treatment.

Printed Name: _______________________________________________________________________

Patient or guardian signature: _________________________________________________________

Date: ________________________________________________________________________________

NOTICE: Please read the Privacy Policy set forth below carefully, as it is designed to provide important information on how and why we collect, use, store, and share your personal information. It also outlines the rights you can exercise regarding your personal information and how you can contact us if you have any questions or complaints.

The Privacy Policy set forth below is legally binding. By visiting, viewing or using this website and/or by using any program, product, course or service from us, you agree to be bound by this Privacy Policy.

Your privacy is important to Colorado Restoration Physical Therapy, Coloradorestorationpt.com, which is operated by Colorado Restoration Physical Therapy, LLC.

We use the term “personal information” to refer to data we collect that may, directly or indirectly, identify, describe, relate to, or be associated with you. This privacy policy (“Privacy Policy”) applies to the personal information we collect when you interact with us through different means, including by visiting and using our website. The term “you” refers to any visitor, viewer, or user of the website and/or any user of any Product. Please note that we cannot control the privacy practices of websites and services that we do not own. 

Please read the entire Privacy Policy before you visit or use the website or perform any Actions (as defined below). By visiting the website or performing any Actions (as defined below), you consent to the terms of this Privacy Policy.

INFORMATION WE COLLECT AND HOW WE COLLECT IT

The following describes the categories of personal information we collect and how we collect such information.

Information You Provide. We collect information you provide to us directly. This includes information you provide when you (i) receive any free or purchase any paid programs, products, courses or services from us (each, a “Product”), (ii) sign up to receive any emails, (iii) comment on any posts or otherwise communicate with us on any social media platform, (iv) register for presentations or classes, (v) fill out any forms, (vi) access public or private membership groups, including those hosted via a third-party platform (i.e., Facebook), (vii) sign up to become our affiliate partner, (viii) respond to any survey, (ix) participate in any contest or sweepstakes, or (x) contact us through any other means, including via an online form, phone call, or email (collectively, the “Actions”).

Examples of data we may receive include your first name, last name, telephone number, email address, shipping address, billing address, physical address (such as your address, state, province, ZIP/postal code and city), date of birth, gender, account name, billing information (such as your credit card number), financial information, Social Security Number, Tax Identification Number, Employer Identification Number, PayPal address, social media information, and other information you provide to us through survey responses, feedback, reviews and other means of communication.

Information Collected Automatically. We collect some data automatically when you visit or use our website or open or respond to our emails. For example, we may automatically collect information when you open or respond to our emails, make a choice with respect to communications we send to you, visit any page that displays our content, provide information to our service providers or purchase or return a Product.

Information from Third Party Sites. We collect some data when you connect with us, comment on or like our posts or otherwise interact with us on any social media platform, or when you access public or private membership groups hosted on a third party platform (i.e., Facebook). Examples of data we may receive include your profile information, profile picture, social media information, social media handles or nicknames, name, purchase history, email address, device identifiers and demographic information.

Information from Internet or Other Electronic Network Activity. We automatically collect some data about your computer or mobile device when you access our website. Examples of data we may receive include your Internet Protocol (“IP”) address, browser type, browser version, cookies from your browser, unique device identifiers, web browser software (i.e., Google Chrome), information about the referring website, the date, time and length of your visit, including the specific pages you visit, information on how you interact with the website, Products and tools and other diagnostic data. Examples of additional data we may receive when you access our website through a mobile device include the type of mobile device you are using, the unique mobile device ID, your mobile operating system, web browser software on mobile, unique device identifiers and other diagnostic data.

PURPOSES FOR COLLECTING INFORMATION

We use your information for business and commercial purposes. For example, we may use your information to:

● Register you for a course, presentation or class.

● Grant you access to a public or private membership group or other account, and maintain and service your profiles for such accounts.

● Validate and authenticate your profile when logging into a public or private membership group or other account or when purchasing a Product.

● Analyze interactions with you to improve quality.

● Identify your product preferences and shopping preferences.

● Secure our website and data.

● Create Products that you are interested in.

● Ship or otherwise deliver, process payment for, communicate about, and track orders of any Products. ● Suggest Products you may like based on past purchases and otherwise personalize your experience with the website.

● Provide promotional and marketing communications and information if you elect to receive it, including email marketing.

● Improve the design, functionality and ease-of-use of our website and Products.

● Respond to any inquiries, reviews or other feedback you submit to us.

● Provide customer service.

● Conduct research to improve our business processes.

● Administer affiliate programs.

● Administer contests, sweepstakes, surveys or promotions.

● Administer any business needs related to your purchase of any Products.

● Detect security incidents and protect against, stop, resolve and prevent any fraud and fraudulent transactions and any malicious, deceptive or illegal activity.

● Comply with all applicable law.

● Respond to legal and regulatory inquiries and assist law enforcement.

DATA RETENTION

We retain personal information as long as it is needed to conduct and operate our business or until you ask us to delete your personal information by contacting us using the contact details provided below. Please note that we cannot control the data retention policies of third parties.

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THIRD PARTY LINKS

For your convenience, we provide links to third party websites on our website, such as links to third party social media platforms. If you click on a link to a third party website, you will be directed to a third party website. We cannot and do not control the privacy policies, content and practices of the website owners and operators of any of the third party websites that we link to. We encourage you to visit their websites directly to learn about their privacy policies.

HOW WE PROTECT YOUR PERSONAL INFORMATION

We care about the security of your personal information, so we maintain reasonable and appropriate physical, technical and procedural safeguards to help keep it safe. While we take reasonable steps to protect your personal information, no method of transmission over the internet or other network can be 100% secure, therefore we cannot and do not guarantee that personal information you transmit will remain secure from misuse or interception in all circumstances. By consenting to this Privacy Policy, you acknowledge that we cannot guarantee that your personal information will be protected from misuse or interception by third parties.

INTERNATIONAL DATA, TRANSFERS AND PROCESSING

Our website is intended for individuals located within the United States. Please be aware that our website servers and our service providers may be located outside of your state, province or country. As a result, some of your personal information may be collected, used, transferred, maintained, disclosed and stored outside of your state, province or country. By using this website, you acknowledge and agree that the collection, use, transfer, maintenance, disclosure and storage of your personal information, Browsing Information and communications related to or arising out of your use of this website is governed by the applicable laws in the United States. While we have the appropriate safeguards in place, the applicable privacy laws in the United States may be less stringent than those of your state, province or country.

NOTICE ABOUT THE GENERAL DATA PROTECTION REGULATION (GDPR NOTICE)

The information in this section, under the subheading “Notice About the General Data Protection Regulation”, applies to individuals covered by the General Data Protection Regulation (“GDPR”). References to “you” and “your” in this section refer only to those covered by GDPR. GDPR, which took effect on May 25, 2018, provides privacy rights for those inside the European Economic Area. For the purposes of this section, “personal information” refers to any information relating to an individual which can be directly or indirectly used to identify such individual. Examples include first name and last name, email address, identification number, information about location, ethnicity, gender, biometric data, web cookies, and religious or political beliefs.

Legal basis for processing information. We may process personal information under the following conditions: (i) we have received your consent to process your personal information for one or more specific purposes, (ii) processing of your personal information is necessary to perform a contract to which you are a party to, or in order to take steps at your request prior to entering into a contract, (iii) processing of your personal information is necessary to comply with a legal obligation we are subject to, (iv) processing of your personal information is necessary in order to protect the vital interests of you or another natural person, (v) processing of your personal information is necessary to perform a task carried out in the public interest or to exercise an official authority vested in us; (vi) processing of your personal information is necessary for the purposes of the legitimate interests pursued by us or a third party, except in certain circumstances where the need for the information is overridden by the need to protect the subject of the personal information (such as when the subject of the personal information is a child).

We are happy to let you know which legal basis applies to the processing of your personal information.

You have certain rights you can exercise under the GDPR, including the following. Please note that this summary is merely provided for your convenience, but we do not warrant the accuracy or exhaustiveness of this summary nor should you rely on this as an accurate or exhaustive list of your rights.

● Right to Access. You have the right to learn whether or not your personal information is being processed. If it is being processed, you have the right to access the personal information, and to learn certain information about your personal information, including: (i) why it is being processed, (ii) the categories of personal information we collected, (iii) the recipients or categories of recipients to whom we have or will disclose the personal information to, (iv) if possible, the amount of time we will store the personal information, or if not possible, the criteria we use to determine such period and (v) available information about the sources for personal information we collected.

● Right to Correction. You have the right to correct any inaccurate personal information about yourself. You also have the right to complete any incomplete personal information collected, including through providing an additional statement.

● Right to Be Forgotten. You have the right to ask us to erase your personal information, which we will do without undue delay under certain circumstances. Examples may include: (i) where the personal information is no longer necessary for the purposes for which it was collected, (ii) where you withdraw consent on the basis of which we processed your personal information, and there is no legal ground for processing such personal information, (iii) where you invoke your right to object (described below) and there are no overriding grounds for processing such personal information, (iv) where your personal information has been unlawfully processed and (v) where the personal information has to be erased to comply with a legal obligation.

● Right to Restrict Processing. You have the right to restrict the processing of your personal information under certain circumstances. Examples may include: (i) where you indicate the inaccuracy of your personal information, (ii) where the processing is unlawful but you would like the processing of your personal information to be restricted as opposed to erased, (iii) where we no longer need the personal information for processing, but you would like it restricted for a legal basis, and (iv) where you invoke your right to object (described below).

● Notification of Recipients of Personal Information. If you exercise your Right to Rectification, Right to Be Forgotten or Right to Restrict Processing (each as described above), we will convey that to each recipient we have shared your personal information with. You have the right to request we provide you with a list of all recipients we have notified.

● Right to Data Portability. You have the right to request your personal information in a structured, commonly used and machine-readable format.

● Right to Object. You have the right to object to the processing of your personal information under certain circumstances. Examples may include: (i) where the personal information is being processed on grounds relating to your personal situation, where the legal grounds for processing such personal information falls under categories (v) and (vi) as described in the sub-section titled “Legal basis for processing information” and (ii) where the personal information is processed for direct marketing purposes.

● Right to Lodge a Complaint. You have the right to lodge a complaint with a supervisory authority. For more information, please contact your local data protection authority.

● Right to Be Informed About International Transfers. You have the right to be informed about the international transfer of your personal information and safeguards in place. Please read the section of this Privacy Policy titled “International Data, Transfers and Processing”.

● Right To Object to Profiling. We may use automated decision-making in operating our website. You have the right not to be subjected to any decisions arising from automated processing, including profiling, which produces legal effects concerning you or similarly significantly affects you.

To exercise any of your rights, please contact us using the contact details provided below. We are required to verify the identity of anyone who makes any request.

CHILDREN’S PRIVACY This website is not directed towards or designed for use by children under the age of 18. This website and the information contained on it is specifically designed for individuals over the age of 18. If you are under the age of 18, you must not access this website or perform any of the Actions. We do not knowingly collect, use, store or share personal information from children under the age of 18. If you know or have reason to believe that we have collected data from anyone under the age of 18, please contact us using the contact details provided for removal of that data.

CHANGES TO THE PRIVACY POLICY We reserve the right to change, amend or modify this Privacy Policy at any time. We will alert you to any changes by posting the effective date of the latest version at the top of this page, at which point any changes will become immediately effective. It is your responsibility to check for updates, as your continued use of the website and our Products after the Privacy Policy is amended will constitute your acceptance and agreement to continue to be bound by the Privacy Policy as of the last updated date indicated at the top of this page.

ALTERNATIVE FORMS

You may print this Privacy Policy by using the “Print” function on your browser.

HOW TO CONTACT US

If you have any questions or complaints related to this Privacy Policy, or would like to exercise any of your rights, please contact us using the information below. 

By Email: Coloradorestorationpt@gmail.com

By Phone: (970) 821-6031

HIPAA Notice of Privacy Practices 

Colorado Restoration Physical Therapy LLC

Dr. Tyler Fosdick, PT, DPT

921 E. Prospect Road

Fort Collins, CO 80525

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

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

1. Uses and Disclosures of Protected Health Information

Your protected health information may be used and disclosed by your healthcare provider, our office staff, and others outside of our office that is involved in your care and treatment to provide healthcare services to you, pay your healthcare bills, support the operation of the healthcare provider’s practice or other uses required by law.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes coordinating or managing your health care with a third party. For example, we would disclose your protected health information, as necessary, to a physician or their medical office that provides care to you. Your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. Since we do not bill your insurance company directly, this is unlikely. But in rare cases, health insurance companies may request information from our office if you have submitted a claim to them for reimbursement. 

Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your provider’s practice. These activities include but are not limited to, quality assessment activities, employee review activities, training of students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to physical therapy students who work with patients in our office. We may also use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law; Public Health issues as required by law; Communicable Diseases; Abuse or Neglect cases; Food and Drug Administration requirements; Legal Proceedings; Law Enforcement; Coroners; Funeral Directors; Organ Donation; Criminal Activity; Military Activity and National Security; Workers' Compensation; Required Uses and Disclosures. Under the law, we must make disclosures to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of Section 164.500.

Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization, or opportunity to object unless required by law.

Your Rights: The following is a statement of your rights with respect to your protected health information.

You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your provider is not required to agree to a restriction that you may request. If your healthcare provider believes it is in your best interest to permit the use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.

By signing this form, you consent to our use and disclosure of protected health information about you for treatment, payment, and healthcare operations. You have the right to request that we restrict how protected health information about you is used or disclosed for treatment, payment, or healthcare operations.

You have the right to revoke this consent in writing, signed by you. However, such a revocation shall not affect any disclosures we have already made in reliance on your prior consent. The Practice provides this form to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The patient understands that: 

• Protected health information may be disclosed or used for treatment, payment, or health care operations.  

• The Practice has a Notice of Privacy Practices and the patient has the opportunity to review this Notice.  

• The Practice reserves the right to change the Notice of Privacy Practices. 

• The patient has the right to restrict the uses of their information but the Practice does not have to agree to the restrictions. 

The patient may revoke this consent in writing at any time, and all future disclosures will then cease. 

The Practice may condition receipt of treatment upon the execution of this consent. The patient acknowledges that he/she has been given the opportunity to obtain a copy of our HIPAA practices.

NOTICE: Please read the Disclaimer set forth below, which is legally binding. By visiting, viewing or using this website and/or by using any program, product, course or service from us, you agree to be bound by this Disclaimer and our Privacy Policy and Terms and Conditions.

 Colorado Restoration Physical Therapy, www.coloradorestorationpt.com, which is operated by Colorado Restoration Physical Therapy LLC provides visitors information on the website as a public service, subject to the following terms and conditions (“Disclaimer”). The term “you” refers to any visitor, viewer or user of the website and/or any user of any free or paid program, product, course or service of the Company (each, a “Product”).

GENERAL DISCLAIMER

The content on this website is provided to you “as is” and is intended to serve as general information. While we strive to provide you with quality content, we give no representation or warranty that the content is accurate, complete, updated, timely, relevant or free from typographical, technical, informational or pricing errors and omissions, whether negligent or otherwise. By using this website or any Products, you agree and acknowledge that your use of this website and use of any Products is solely at your own risk. This Disclaimer was created with the help of Plug and Law and Privacy Policy Solutions.

NOT PROFESSIONAL ADVICE

This website does not contain professional advice, nor is any professional-client relationship established with you through your use of this website. Any information found on or derived from this website should not be a substitute for and cannot be relied on as any legal, tax, real estate, medical, financial, risk management, marital or other professional advice. If you require any such advice, please consult with a licensed or knowledgeable professional in that area before taking any action.

YOUR RESPONSIBILITY

It is your responsibility to take all necessary steps to independently verify and ascertain that any information you choose to rely on from, access through or take action based upon this website or our Products is accurate, as we are not responsible for your use of the information obtained from or accessed through this website or our Products. Any views expressed on this website are solely the personal views of the author and do not necessarily reflect the views of the Company.

EARNINGS DISCLAIMER

While we may, on this website, through any of our Products or in our communications, reference certain results or outcomes, you agree and acknowledge that information about these results or outcomes are received from third parties and we have no control over the accuracy of such statements, nor is there any guarantee that you can achieve the same results or outcomes. You agree and acknowledge that these results are not guaranteed or typical in any way and that individual outcomes may vary. Please do not rely on these results or outcomes in using the website or purchasing any Products.

THIRD PARTY LINKS

Our website may contain links to third party websites, for example, through hyperlinks we provide or through banners or advertisements, solely as a convenience to you. However, we are not responsible for any content found on or accessed through any links to third party websites. Any links to third party websites we provide do not serve as endorsements by us for the third party website or any of the products or services you may find on such website. We have no control over third parties and assume no responsibility for any third party websites or any of the products or services you may find on such websites, even if you access a third party website through a link on this website. If you choose to access a third party website, it is solely at your own risk.

TESTIMONIALS DISCLAIMER

This website may contain testimonials by users of our Products. Each testimonial reflects solely the personal view, opinion or experience of the individual providing the testimonial and does not reflect our views or opinions. You should not rely on any testimonial as indicative of a certain result or outcome. We do not claim, nor should you assume that your use of our Products will lead to the same result or outcome. We also do not independently verify, nor can we guarantee the accuracy of any information provided in such testimonials.

Except for correcting spelling and grammatical errors, each testimonial appears verbatim as we have received it. We do not pay or provide any form of compensation to individuals for providing testimonials.

AFFILIATE DISCLAIMER

This website may contain links to affiliate websites. When you click on and/or make a purchase through an affiliate link placed on our website, we may receive a small commission or other form of compensation at no additional cost to you. Please assume that any links contained on our website are affiliate links. Our use of affiliate links does not influence the products, services and websites that we share with you. This Disclaimer applies to all of the various means we use to communicate with you, including via this website, email, phone, social media, our Products or otherwise.

FAIR USE DISCLAIMER

We may use copyrighted material on our website without specific authorization. In these instances, we do so because we believe such use constitutes fair use of any such copyrighted material under Section 107 of the United States copyright law.

CHANGES TO THE DISCLAIMER

We reserve the right to amend this Disclaimer at any time without notice to you. We will alert you to any changes by posting the effective date of the latest version at the top of this page, at which point any changes will become immediately effective. It is your responsibility to check for updates, as your continued use of the website and our Products after this Disclaimer is amended will constitute your acceptance and agreement to continue to be bound by this Disclaimer, as amended.

Colorado Restoration Physical Therapy is committed to providing solutions to make our website and our client’s websites available to as many people as possible by meeting the requirements of the Americans with Disabilities Act (ADA). We will make every effort to ensure that website-based communications are accessible to those with visual, hearing, cognitive, and motor impairments. 

Colorado Restoration Physical Therapy acknowledges that internet users with disabilities can find websites difficult to use. We recognize this important issue and are taking necessary steps to ensure that all Custom Physical Therapy developed websites are accessible in accordance with known guidelines framed by industry-standard techniques and practices to provide an acceptable level of ADA accessibility for website users. These include, but are not limited to, usability characteristics for screen reader users, keyboard-only users, and users with impaired hearing and vision.