What HIPAA Actually Requires for Your Chiropractic Website (And What It Doesn't)

HIPAA's Privacy Rule applies to chiropractic practices as covered entities because you transmit health information electronically for billing. This coverage extends to your marketing activities, but the scope is narrower than many chiropractors assume.

Protected Health Information (PHI) includes any individually identifiable health information you create, receive, or maintain. In marketing contexts, this means:

• Patient names connected to their status as your patient
• Images that could identify someone as receiving chiropractic care
• Any health details disclosed in testimonials or case descriptions
• Website visitor data that could link browsing behavior to a patient identity

However, HIPAA does not prohibit marketing. It establishes what authorizations you need before using PHI for promotional purposes. Many compliant marketing activities require no special authorization at all—general educational content about spinal health, community event sponsorships, and service descriptions involve no individual patient information.

Disclaimer: This is educational content about HIPAA requirements, not legal advice. Consult a healthcare compliance attorney or your state chiropractic board for guidance specific to your practice situation.

The practical compliance question is rarely "can I market?" but rather "what safeguards do I need for this specific marketing activity?" That distinction shapes every decision from testimonial collection to analytics configuration.

Using patient testimonials in chiropractic marketing requires a signed HIPAA authorization form—separate from your treatment consent and Notice of Privacy Practices. This authorization must meet specific criteria under 45 CFR § 164.508:

• Description of the specific PHI to be used (the testimonial content)
• Identification of who will receive the information (your website, social media, print materials)
• Purpose of the disclosure (marketing)
• Expiration date or event
• Right to revoke authorization
• Statement that signing is voluntary

Before/after adjustment imagery adds complexity. These images constitute PHI because they document treatment, even without visible faces. You need specific written authorization describing exactly how images will be used, where they'll appear, and for how long.

In our experience working with chiropractic practices, the safest approach separates testimonial authorization from the clinical visit entirely. Asking patients to sign marketing authorizations during intake creates pressure that could compromise the "voluntary" requirement. Instead, follow up after treatment completion when patients express satisfaction organically.

Video testimonials require the same authorization but add practical considerations: patients should review footage before publication and have clear understanding that video can be screenshot or shared beyond original platforms. Document this understanding in your authorization form language.

Meta Pixel, Google Analytics, and other tracking technologies present the newest—and often overlooked—HIPAA compliance risk for chiropractic websites. The core issue: these tools transmit data to third parties who aren't covered entities and haven't signed Business Associate Agreements with your practice.

When a current patient visits your website while logged into Facebook, the Meta Pixel can connect their browsing behavior to their identity. If they visit a page about sciatica treatment, you've potentially disclosed PHI to Meta without authorization. The same risk applies to Google Analytics 4, which collects IP addresses and can be combined with other Google data to identify individuals.

High-risk scenarios for chiropractic websites:

• Retargeting ads to website visitors who browsed specific condition pages
• Remarketing lists built from patients who scheduled appointments online
• Form-tracking pixels that fire when someone submits intake information
• Conversion tracking tied to appointment confirmations

The Office for Civil Rights has not issued definitive guidance on tracking pixels, but several health systems have settled investigations after disclosures involving these technologies. For chiropractic practices, the conservative approach is limiting pixel placement to non-PHI pages, excluding logged-in patient portal areas entirely, and avoiding any tracking tied to appointment scheduling or form submissions.

Server-side tracking and privacy-focused analytics tools offer alternatives, though implementation requires technical configuration beyond standard marketing setups.

Online intake forms streamline patient onboarding but require specific safeguards under HIPAA's Security Rule. The transmission, storage, and vendor relationships all carry compliance obligations.

Encryption requirements: All PHI transmitted through your website must use encryption in transit (HTTPS with TLS 1.2 or higher). Forms must submit to servers with encryption at rest. Standard contact forms through WordPress or basic website builders typically don't meet these requirements without additional configuration.

Business Associate Agreements: Any software vendor that receives, stores, or processes patient intake information must sign a BAA with your practice. This includes form builders (JotForm, Typeform, Google Forms), practice management software, and any integration tools connecting them. Without a BAA, using these services for patient information violates HIPAA regardless of their technical security measures.

Patient scheduling widgets present similar requirements. If a patient enters their name, contact information, and reason for visit into an online scheduler, that's PHI. The scheduling software vendor needs a BAA, and the transmission needs encryption.

Common compliance gaps we observe:

• Contact forms asking "reason for visit" without encryption or BAA
• Chat widgets that store conversation logs on non-compliant servers
• Scheduling tools marketed to general businesses without healthcare compliance features

Several chiropractic-specific practice management platforms include compliant intake forms and scheduling. Implementing these purpose-built tools typically costs less than retrofitting general software for HIPAA compliance.

Online reviews create a compliance tension: patients can say anything about their experience publicly, but your response options are constrained by HIPAA even when reviews are negative or inaccurate.

The core rule: You cannot confirm or deny that someone is your patient without their authorization. This applies even when a patient initiates the public disclosure by leaving a review.

A patient writing "Dr. Smith helped my lower back pain" gives you no automatic permission to respond "Thank you, we're glad your treatment went well." That response confirms they received treatment—a PHI disclosure. The safest compliant responses acknowledge the review without confirming any treatment relationship:

• "Thank you for taking the time to share your feedback."
• "We appreciate you reaching out. Please contact our office directly at [phone] so we can discuss your concerns."
• "Patient satisfaction is important to our practice. We'd welcome the opportunity to speak with you directly."

For negative reviews containing inaccurate clinical information, the impulse to correct the record can create legal exposure. Disputing specific claims about treatment may require disclosing PHI to defend your position. In most cases, a general response inviting offline conversation protects the practice better than point-by-point rebuttal.

Review solicitation practices also carry compliance considerations. Asking all patients for reviews is generally fine; selecting patients based on treatment outcomes or conditions could constitute using PHI for marketing without authorization. Broad, non-targeted review requests avoid this issue.

HIPAA establishes the federal floor for health information privacy, but state chiropractic boards often impose additional advertising restrictions. These rules vary significantly by state and change with regulatory updates—verify current requirements with your licensing authority.

Common state-level restrictions include:

• Prohibitions on claiming to treat specific conditions outside chiropractic scope of practice
• Requirements for disclaimer language on testimonial advertisements
• Restrictions on before/after imagery implying specific outcomes
• Rules about using terms like "specialist" or "expert" without board-recognized credentials
• Mandatory disclosure of advertising relationships or sponsorships

Several states require that patient testimonial advertisements include disclaimers stating results aren't designed to and may vary. These requirements exist independent of HIPAA and apply even when you have proper PHI authorization.

FTC regulations add another layer: testimonial advertising that implies typical results requires either substantiation or clear disclosure that results aren't representative. For chiropractic practices, this means testimonials claiming specific outcomes ("eliminated my migraines," "no more pain after three visits") need either data supporting those results as typical or prominent disclaimers.

The intersection of HIPAA, state board rules, and FTC requirements means compliant testimonial use requires checking three separate [regulatory framework](/resources/attorney/law-firm-seo-compliance)s. Many practices simplify by limiting testimonials to general satisfaction statements rather than specific clinical outcomes.