LiabilityI, your name* , hereby release aki sasagawa from any liability or claims that could be made against her concerning my mental and/or physical well-being during the work that has been outlined and agreed upon (now and in the future) by filling out and signing this form.
Scope of Practice I understand that aki sasagawa is not a licensed physician, psychologist, or medical practitioner of any kind and that Energy Healing / Reiki should not be considered a replacement for the advice and/or services of a psychiatrist, psychologist, psychotherapist, physician, or doctor. Participation I give aki sasagawa full permission to give me Energy Healing / Reiki Reading session(s) and by participating fully in the process, I play an important role in my overall success and well-being. Guarantee I understand that aki sasagawa cannot and does not guarantee results since my own personal success depends on many factors that she has no control over, including my willingness and desire to affect the changes inside of myself. Audio / Video Recording(s) There will be no audio/video recordings permitted by any parties during the Energy Healing / Reiki session(s) unless otherwise agreed by all parties in writing. A video recording is optional for Past Life Regression for no additional fees. Confidentiality By signing this form, I consent that aki sasagawa may release information to a specific individual or agency if it has been determined that a child or elder is at risk of or is currently being abused; if I, as a client, am in imminent danger to myself or others; or if a subpoena of records has been requested. Cancellation, Rescheduling, No Show, and Refund PolicyShould you need to cancel or reschedule your appointment, please contact aki sasagawa immediately at 424.387.9011. For any cancellation made less than 24 hours advance notice, there is no refund and there will be a $25 USD reschedule fee. An appointment that is missed or that neglected to give notice (No Call / No Show) will result in a charge of the full price of the scheduled service. Once the service is rendered, there will be no refund available.