• Phin Wellness Client Consent/Intake Form

    Phin Wellness Client Consent/Intake Form

  • I understand that Reiki is a stress reduction and relaxation technique. I acknowledge that sessions administered are only for the purpose of helping me relax and to relieve stress. Reiki Practitioners do not diagnose conditions, nor do they prescribe substances or perform medical treatment, 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 or condition I may have. 

    I also understand the body has the ability to heal itself, and to do so complete relaxation is often beneficial. Long-term imbalances in the body require multiple sessions to allow the body to reach the level of relaxation necessary to bring the system back into balance.

    I understand and believe that self- improvement requires commitment on my part, and that I must be willing to change in a positive way if I am to receive the full benefit of Reiki. 

    I acknowledge my commitment to my self-improvement process. I recognize that a Reiki session program must be followed to be truly effective, j ust as prescribed medication is only effective if taken as directed. 

    I understand the above statement in regards to services offered and give permission to Oshien Burrell of Phin Wellness to perform such services as outlined above, and state that I have disclosed any information (health or otherwise) that may alter the effectiveness of services offered. 

    I understand that if at any time I feel discomfort or have a problem with the session, it is my responsibility to voice my concerns. 

    I understand that payment is required prior to the services offered; I must give 24 hours notice for cancellations to avoid cancellation fees; and at any time during a session I can request to stop session, though this may not entitle me to a refund.

  • Date
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  • Date of Birth
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  • Format: (000) 000-0000.
  • Are you currently taking any medication?
  • Are you currently under the care of a family physician or specialist?
  • Are you currently receiving alternative treatments?
  • Do you or have you ever suffered from seizures of any sort?
  • Are you OK with being touched "appropriately" during the Reiki session?
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  • Should be Empty: