Reiki Client Intake Form and Waiver
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Name
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First
Last
Address:
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their you
Date of Birth
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Primary Phone:
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Email
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Emergency Contact: (please list name and phone number)
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Are you a returning client? If so, choose Yes and click on waiver below, if you are a new client please complete form.
Yes
No
Have you ever had a Reiki session before?
Yes
No
How did you hear about Infinite Space Reiki?
Briefly list any particular area of concern or intention for your session? (optional)
Are you sensitive to scents or fragrances? If yes, please list below.
Are their any areas where you are sensitive to touch, if so please list below. (optional)
Reiki Client Waiver
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Check here to agree to this waiver.
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 compliment 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. I release Infinite Space Reiki and it’s sole practitioner from any legal liability during my voluntary participation in the Reiki session with Infinite Space Reiki. By providing my e-signature below I acknowledge that I have read and consent to all terms listed wherein.
E-signature:
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