Reiki Consent and Release Form

REIKI CONSENT AND RELEASE FORM

I, the undersigned, understand that the Reiki session given involves a natural "hands-on" method of energy balancing for the purpose of stress reduction, and relaxation. I understand very clearly that a Reiki session is not a substitute for medical, or psychological diagnosis, and treatment.

I understand that Reiki practitioners do not diagnose conditions, nor do they prescribe substances, nor interfere with the treatment of a licensed medical professional. It is recommended that I see a licensed physician, or licensed health care professional for any physical, or psychological ailment I have.

I understand that those under the age of consent require their parent or guardian to attend all sessions and to sign this form.

I understand that payment of fees for services rendered is an acknowledgment of my satisfaction with the services provided, or if there is no charge for this session, I will initial this form in the box marked "Fee".

Name:

Date of birth:

Address:

Occupation:

Home phone:

Work phone:

Mobile phone:

Today’s date:

Fax phone:

Signature:

Email:

Progress and Session Record

Date

Length

Fee

Remarks/Follow-up