Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Phone *
Phone
Have you ever had a Reiki session before? *
Are you sensitive to perfumes or fragrances? *
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 healthcare professional for any physical or psychological ailment I may have. I understand that Reiki 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 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.
Date
Date
Stress Level: Pain Level: Quality of Life: