CLIENT DISCLOSURE STATEMENT and ACKNOWLEDGEMENT OF INFORMATION SHARING PRACTICES

1. Shared Services Arrangement of Common Table Collective

This Disclosure Statement (“Disclosure”) is provided to you as a client of Common Table Nutrition Collective (including Rochelle Adriano Nutrition, Jamie Clayton Nutrition, Geanna Revell Nutrition, and Maria Taylor Nutrition), a professional limited liability company organized under the laws of the State of Washington. This Disclosure explains how your information may be shared within the context of our shared services arrangement as a collective of registered dietitian nutrition businesses sharing common resources. Common Table Nutrition Collective provides shared management of administrative services, resources, and certain expenses for its members that each have their own clients.

2. Information Sharing Disclosure

Each member collects and maintains certain client information in connection with providing professional dietitian services. This information is stored in a shared health records management database maintained by the Collective. This database is technically accessible to all members of the Collective providing professional dietitian services to clients.

By engaging Professional’s services, you acknowledge and consent to the following information sharing practices:

Shared Database Access. Your client information will be stored in a shared health records management database that is primarily for the use of your dietitian and is accessible to the other member professionals participating in the Collective.

Purpose of Information Sharing. We use your personal information in a manner consistent with this Disclosure and in the context of our professional relationship with you. Information sharing among member professionals is limited to the following purposes:

(a) Administration of client accounts and service delivery;

(b) Billing and collection purposes;

(c) Coordination of professional services between members when applicable;

(d) Management of shared expenses and resources;

(e) Compliance with professional and legal obligations.

Scope of Shared Information. Information that may be shared includes contact information, service history, billing information, and other data necessary for the administration of professional services.

3. Confidentiality Safeguards

Despite this information sharing arrangement, the Collective and its members are committed to protecting your confidentiality. The following safeguards are in place:

(a) Professional Obligations. All participating member professionals remain bound by their respective professional ethical obligations regarding client confidentiality.

(b) Access Controls. Access to the shared database is restricted to authorized member professionals and any staff hired and overseen by the Collective, on a need-to-know basis.

(c) Security Measures: The Collective implements reasonable technical, administrative, and physical safeguards designed to protect the security and confidentiality of client information.

4. Legal Compliance

This information sharing arrangement complies with applicable Washington State laws and regulations governing professional services and client confidentiality. Nothing in this Disclosure is intended to waive any legal privileges that may apply to your communications with Professional.

5. Client Acknowledgement

By engaging a member of Common Table Nutrition Collective’s services after receiving this Disclosure, you acknowledge that you have read and understand the information sharing practices described herein and consent to the sharing of your client information as specified in this Disclosure.

Effective Date: July 6, 2026