Complementary & Alternative Health Care
Client Bill of Rights

Roxann Keyes | 684 Excelsior Blvd. Suite 120, Excelsior, MN 55331 | 612-270-6323

As of July 1, 2001, Minnesota’s Freedom of Access to Complementary Care Law (Statue Chapter 146A) requires that you receive and acknowledge that you have received, by your signature on the bottom of this page, the following information prior to your treatment.

Roxann Keyes, hereafter, “the Practitioner” has receive the following education, training, and credentials.

Training:

Colorado School of Healing Arts – Lakewood, Colorado, 2003
Swedish, Deep tissue, Neuromuscular, Trigger Point, Sports massage, Trauma Touch Therapy

Certified Massage Therapist
Certified Trauma Touch Therapist
Certified Reiki Practitioner

The information that follows in quotation marks is required to be on the Client Bill of Rights in bold by the state statute: “THE STATE OF MINNESOTA HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS. THIS STATEMENT OF CREDENTIALS IS FOR INFORMATION PURPOSES ONLY. Under the Minnesota law, an unlicensed complementary and alternative health care practitioner may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis from a licensed physician, chiropractor, or acupuncture practitioner, or services from a physician, chiropractor, nurses, osteopath, physical therapist, dietitian, nutritionist, acupuncture practitioner, athletic trainer, or any other type of health care provider, the client may seek such services at any time.”

Standards of Practice

Massage Therapists apply a variety of scientifically developed massage techniques to the soft tissue of the body to improve muscle tone and circulation. Massage Therapists work to enhance well-being, reduce the physical and mental effects of stress and tension, prefent disease, and restore health.

Complaints

Please address any complaints with your therapist. Clients may also contact the Office of Unlicensed Complementary and Alternative Health Care located in Minnesota Department of Health. The address is P.O. Box 64882, St Paul, MN 55164-0882.
Website: www.health.state.mn.us  |  Phone: 651-201-3728

Records

Client records and transactions with the practitioner are confidential, unless release of these records is authorized in writing by the client, or otherwise provided by law.

The client has a right to be allowed access to records and written information from records in accordance with sections 144.291 to 144.298.

Choosing a Therapist

Certified Massage Therapists have over 500 hours of professional training in anatomy, physiology, and massage therapy techniques and can provide you with a relaxing, stress-reducing massage as well as relieve tension due to injuries and overuse.

Other massage therapy services are available to the client in the same community. These can be located by asking the Practitioner, the provider who referred you to this Practitioner, the phone book, or the following practitioner database: www.massagetherapy.com.

Right to Current Information

Clients have the right to complete and current information concerning the practitioner’s assessment and recommended service that is to be provided, including expected duration of the services to be provided.

Personal Interaction

Clients have the right to expect courteous treatment, free from verbal, physical, or sexual abuse.

Right of Agency

The client has the right to choose freely among available practitioners and to change practitioners after services have begun, within the limits of health insurance, medical assistance, or other health programs.

Right to Refuse or Change Therapists

The client may refuse services or treatment unless otherwise provided by law, and has the right to coordinate a transfer of records if there is a change in the provider of services.

Right of No Retribution

The client has the right to refuse service or treatment at any time, unless provided by law. The client may assert the client’s rights without retaliation.

Fee Structure & Changes

All clients have a right to reasonable notice of changes in service or charges. A fee will be quoted when an appointment is scheduled. You will be notified of any changes prior to the appointment.

COVID-19 Information & Liability Waiver

COVID-19 Information

Consent for Treatment

I understand that, because massage therapy work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.

Typing your name in the box below represents your digital signature on this form.

COVID-19 Pre-Screening

By attending my appointment…
I agree that I am not currently experiencing any of these symptoms:

Please note: Other less common symptoms have been reported, including gastrointestinal symptoms like nausea, vomiting, or diarrhea. 

I agree that I have not:

If you have experienced any of the above, please reschedule your appointment at least 14 days from now.

If I have tested positive for Covid-19, have quarantined and recovered, I will have taken a Covid-19 test and have a negative result before going to the appointment.

If I have received vaccinations, I will provide vaccination dates to my practitioner at the time of appointment to be entered into my Health Chart.

Contact Us

Center for Life Design
684 Excelsior Blvd, Ste 120
Excelsior, MN 55331