Notice of Privacy Practices

Last updated: September 18, 2026

Our commitment

Aktive Motion Physical Therapy is required by law to maintain the privacy of your protected health information ("PHI"), to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we may use and disclose your health information

For treatment

We use your health information to provide physical therapy and to coordinate your care. For example, we may share information with your physician, your surgeon or another therapist involved in your treatment.

For payment

We may use and disclose your information to bill and collect payment from you, your insurance company or another payer, for example to verify benefits, obtain prior authorization or submit a claim.

For health care operations

We may use your information for quality assessment, staff review, training, licensing, business planning and general administration of the practice.

Appointment reminders and follow-up

We may contact you by phone, text, email or mail to remind you of an appointment, follow up after a visit, or discuss treatment alternatives.

Individuals involved in your care

Where you agree, or where it is reasonable to infer from the circumstances that you do not object, we may share information relevant to your care with a family member, caregiver or other person you identify. Because we treat you in your home, please tell us if there is anyone present whom you do not wish to have hear clinical discussion.

As required or permitted by law

We may use or disclose your information without your authorization when required by law, including for public health activities, reporting of abuse or neglect, health oversight activities, judicial and administrative proceedings, law enforcement purposes, coroners and funeral directors, organ donation, research under approved protocols, to avert a serious threat to health or safety, for specialized government functions, and for workers' compensation claims.

Uses that always require your written authorization

We will obtain your written authorization before we use or disclose your information for marketing purposes, before we sell your information, and before we disclose psychotherapy notes where any exist. You may revoke such an authorization in writing at any time, except to the extent we have already acted on it.

Your rights regarding your health information

• Right to inspect and copy. You may inspect and obtain a copy of your record, including an electronic copy where we maintain it electronically. We may charge a reasonable, cost-based fee.
• Right to amend. If you believe information in your record is incorrect or incomplete, you may ask us to amend it. We may deny the request in certain circumstances, and will explain why in writing.
• Right to an accounting of disclosures. You may request a list of certain disclosures we have made of your information.
• Right to request restrictions. You may ask us to restrict how we use or disclose your information. We are not required to agree, except that we must agree to a request not to disclose information to a health plan when you have paid for the service in full out of pocket.
• Right to confidential communications. You may ask us to contact you in a specific way or at a specific location, and we will accommodate reasonable requests.
• Right to a paper copy of this notice. You may request one at any time, even if you agreed to receive it electronically.
• Right to be notified of a breach. We will notify you if a breach occurs that compromises the privacy or security of your information.

To exercise any of these rights, contact us at contact@aktivemotionpt.com or (239) 280-0368.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us using the contact details below, or with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201. You will not be retaliated against for filing a complaint.

Changes to this notice

We reserve the right to change this notice and to make the revised notice effective for information we already hold as well as information we receive in the future. The current notice will always be posted on this page with its effective date.

Contact

Privacy contact: Dr. Jean Dornevil, DPT
Aktive Motion Physical Therapy · Naples, Florida
Phone: (239) 280-0368
Email: contact@aktivemotionpt.com

Effective date: September 18, 2026