Reiki Waiver & Liability Form

Reiki Intake & Liability Waiver
What is Reiki?The Usui System of Reiki Healing is a palms-on healing practice. Reiki is an ancient laying-on-of-palms healing technique that uses the Universal life force energy to balance the subtle energies within our bodies and to heal. Reiki practitioners act as a conduit or channel through which Reiki energy travels. The intended result of receiving Reiki is a balanced physical, mental, emotional, and spiritual being. Reiki is being used today in clinics and hospitals all over the world to support health, wellness and transition.
1. Contact Information *
2. Emergency Contact: *
3. Current Medications and dosage: *
4. Are you currently under the care of a physician? *
5. If yes, physician?s name
6. Have you ever had a Reiki session before? *
7. If yes, when was your last session?
8. Do you have a particular area of concern? *
9. Are you sensitive to perfumes or fragrances? *
10. Are you sensitive to touch? *
I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. I understand that Reiki can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.
Privacy Notice:
No information about any client will be discussed or shared with any third party without written consent of the client or parent/guardian if the client is under 18.
Please sign here *