PRIVACY POLICY & HIPAA NOTICE OF PRIVACY PRACTICES
Revive Wellness and Aesthetics, LLC

Last Updated: 4/20/2026

This Privacy Policy & Notice of Privacy Practices describes how Revive Wellness and Aesthetics, LLC (“we,” “our,” or “us”) may use and disclose your protected health information (“PHI”) and how you can access this information. Please review it carefully.

1. Information We Collect

We may collect the following:

Personal Information

• Name, phone number, email address, date of birth
• Billing and payment information (including credit card on file)
• Emergency contact information

Health Information (Protected Health Information - PHI)

• Medical history, medications, allergies
• Treatment records, provider notes, and service history
• Before-and-after photos (with consent)

Technical Information

• Device, browser, IP address, and booking activity through our systems

2. How We Use and Disclose Your Information

For Treatment, Payment, and Healthcare Operations

We may use and share your PHI to:

• Provide, coordinate, and manage your care and treatments
• Process payments and manage billing
• Operate and improve our practice

Other Permitted & Required Uses

We may also disclose your information:

• As required by federal or state law
• For public health and safety purposes
• To prevent or lessen a serious threat to health or safety
• For health oversight activities (e.g., licensing, audits)

With Your Authorization

We will obtain your written authorization for uses not otherwise permitted, including:

• Marketing communications beyond standard practice updates
• Use of identifiable photos or testimonials

You may revoke authorization at any time in writing.

3. Your Rights Under HIPAA

You have the right to:

• Access Your Records – Request copies of your health and billing records
• Request Corrections – Ask us to correct inaccurate or incomplete information
• Request Confidential Communications – Ask us to contact you in a specific way (e.g., phone, email)
• Request Restrictions – Ask us to limit how we use or share your information
• Receive an Accounting of Disclosures – Request a list of certain disclosures of your PHI
• Receive a Copy of This Notice – You may request a paper or electronic copy at any time

4. Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your PHI
• Provide you with this Notice of our legal duties and privacy practices
• Notify you following a breach of unsecured PHI when required
• Follow the terms of this Notice currently in effect

5. Data Security

We implement appropriate administrative, technical, and physical safeguards to protect your information. Payment data is securely handled by compliant third-party processors, and electronic records are maintained in secure systems.

6. Third-Party Services

We may use third-party platforms (such as PatientNow or similar systems) for scheduling, communication, and recordkeeping. These providers are required to safeguard your information and comply with applicable privacy regulations.

7. Marketing & Communications

We may contact you regarding appointments, treatment information, and promotions. You may opt out of marketing communications at any time.

8. Retention of Information

We retain medical and personal information as required by law and for legitimate business purposes.

9. Changes to This Notice

We reserve the right to update this Privacy Policy & Notice at any time. Updates will be posted with a revised effective date and apply to all information we maintain.

10. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health & Human Services. You will not be penalized for filing a complaint.

11. Contact Information

Revive Wellness and Aesthetics, LLC
Kristin Jeziorny, FNP-C
312-841-8147
revive.mobilewellness@gmail.com

By using our services, you acknowledge that you have received and understand this Privacy Policy & HIPAA Notice of Privacy Practices.