Reiki Client Information Form
  • Reiki Client Information Form

    Acknowledgement & Consent to Receive Treatment
  • Sharmaine Nicole Pasion

    Certified Usui & Tibetan Reiki Master Teacher 

    Phone Number: +1 (949) 880-9080

    Email: reikiwithpasion@gmail.com

    Webstei: https://reikiwithpasion.com/ 

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  • A.  Identification

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  • Format: (000) 000-0000.
  • What is Reiki?

    Reiki is a of complementary healthcare practice, which have been found to enhance the body's ability to heal itself. 


    What Reiki is not ?

    Your practitioner is not a licensed physician, and Reiki does not require licensing by the state. They are meant to be a complement to "healing arts services licensed by the state"; i.e., they are a complement to traditional western medicine provided by doctors, nurses, and other licensed medical professionals.


    Theory of Treatment

    Stress, trauma and illness restrict the natural flow of ki (chi) or "life force energy" through the body. By restoring the flow of life force energy through the body, Reiki rejuvenates the bod's ability to heal itself.

    Although one session may be adequate, long-term imbalances in the body sometimes require multiple treatments in order to allow the body to reach the level necessary to bring the system back into balance. Improvement often requires commitment on the client's part (e.g., willingness to make lifestyle changes) in order to fully benefit from Reiki treatment.


    California State Senate Bill SB 577

    California State Senate Bill SB 577, which was signed by the Governor in September 2002, has profound implications for the practice of alternative forms of healthcare in California. SB 577 enables alternative and complementary healthcare practitioners (including, but not limited to Reiki) to provide and advertise legally. They must also;however, comply with certain requirements specified within the bill.


    What does Senate Bill SB 577 mean for you?
    SB 577 provides you with access to alternative and complementary healthcare practitioners.

    You must be given information about the nature of the treatment and practitioners qualifications. Feel free to ask a practitioner any questions you might have about our treatment. Check to see if your practitioner has been certified by a professional membership society. In addition, tell your doctor about any alternative treatment you are pursuing. You can also request that your licensed and unlicensed health care providers communicate with each other and work collaboratively to meet your health care needs.


    How SB 577 helps to protect you. 

    SB 577 requires unlicensed alternative healthcare practitioners to follow certain guidelines and restrictions.

    Here are the things that unlicensed alternative healthcare practitioners are not allowed to do:

    • Perform any surgery or any procedure that punctures the skin or harmfully invades your body.
    • Use X-Ray radiation.
    • Prescribe prescription drugs or recommend that you discontinue drugs that were prescribed by a licensed physician.
    • Set fractures.
    • Treat wounds with electrotherapy.
    • Put vou at risk of great bodily harm.
    • Imply in any way that they are a physician.

    In addition, an unlicensed alternative health care practitioner must do the following things. Provide you with a statement, written in plain language that includes the following information:

    • That they are not a licensed physician and that their services are not licensed by the state.
    • A brief clear description of the kind of services they provide and the reason behind it.
    • A description of their training.
    • Ask you to sign an acknowledgement that you received a Client Information and Consent to Receive Treatment Form and provide you with a copy of it.
    • They must keep a copy of your signed acknowledgement for 3 years.

    Nature of the Services Provided

    During a Reiki session the client is asked to lie down. You will remain fully clothed during the treatment sessions. The majority of the sessions will involve the practitioner holding their hands 2 to 3 inches above the client's body. If guided to do so, the practitioner will ask permission to place their hands on your body but onlv in a manner acceptable to you and within the legal limits of their practice as a Reiki Practitioner. Once the session begins, the practitioner allows the life force energy to flow through their hands, which may be experienced by the client as heat, coolness, vibrating, tingling, a light pressure, a slight pulling sensation or nothing at all. The Practitioner may also use other hands-off techniques, such as sweeping the body of unneeded energy or using vocal tones to break up energy blocks. The practitioner is simply a conduit or channel of life force energy. It is believed that the energy is guided by God, Source or Spirit for the physical, mental, emotional and/or spiritual well-being of the client. Therefore, a specific outcome cannot be guaranteed by the Reiki Practitioner.

    Sharmaine Nicole Pasion Qualifications

    Sharmaine Nicole Pasion is a Certified Usui/Tibetan Reiki Master/Teacher. She received all her certifications in Reiki from Katherine McBride at Reiki Earth Mother in San Juan Capistrano, California from a Reiki Master Teacher and and Karuna Reiki® Master Teacher, Certfiedat Life Coach and is also registered with the International Center for Reiki Training as a Karuna Reiki® Master /Teacher. 

    Acknowledge & Consent to Receive Services

    In order to use Sharmaine Nicole Pasion's services, California state law requires that you acknowledge receipt of the information provided in this form and that you sign it. Copies will be kept for 3vears.

    • I have read and understand the above guidelines and disclosures about the treatments and techniques offered by Sharmaine Nicole Pasion and her training and education.
    • I have discussed any concerns I have about the nature of the treatment she will be providing.
    • If I experience any discomfort during the session(s), I agree to immediately inform Sharmaine.
    • I understand that Sharmaine is not a licensed physician and that the alternative services she is providing me are not licensed by the state of California.
    • I understand it is my responsibility to maintain a relationship for myself, child or pet with a medical doctor or veterinarian.
    • I understand that Reiki is not a substitute for medical treatment or medications.
    • I am aware that Sharmaine Nicole Pasion does not diagnose illness or disease nor does she prescribe medications or recommend supplements.
    • I understand that any suggestions that are provided to me should not be taken as diagnosis or recommendation against the advice of a licensed physician or mental medical professional.
    • I have consented to use the services offered by Sharmaine Nicole Pasion and agree to be personally responsible for her fees in connection with the services provided.
  • CLIENT ACKNOWLEDGEMENT

    I have read and understand the above disclosue regarding the treatement I will be receiving from Sharmaine Nicole Pasionn. I have been provided with a copy of this document in accordance with California State Law SB577. 

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