Informed Consent Waiver​

​(Client will sign & date in person at their first appointment.)

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I understand that close contact with people increases the risk of infection with COVID-19. By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive massage from Kathleen Rhyne, OR LMT #20409.

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I understand that if there is a positive COVID-19 case associated with Birch Family Massage, LLC, my contact information may be provided to the county or state health authority to assist with contact tracing.

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I understand that Birch Family Massage, LLC has adopted required policy changes and recommended procedures from the Oregon Health Authority and the Oregon Board of Massage Therapists, and I will comply with these guidelines during my appointment (or choose to reschedule).

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I will inform Birch Family Massage, LLC if I or anyone in my household is positively diagnosed with COVID-19 within 5 days of my appointment.