Celestial Reiki Client Information Form

  • Celestial Reiki Client Information Form

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Emergency Contact

  • Format: (000) 000-0000.

  • Medical Data

  • Are you currently under the care of a physician?*
  • Have you ever had a Reiki session before?*
  • If Yes, when was your last session?
     - -

  • Acknowledgment

  • 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 complement 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.

    Privacy Notice: 

    No information about any client will be discussed or shared with any third party
    without written consent of the client or parent/guardian if the client is under 18.

     

    I acknowledge that all information I have provided in this form is true and accurate.

  • Date Signed*
     - -

  • Privacy Notice: 

    No information about any client will be discussed or shared with any third party
    without written consent of the client or parent/guardian if the client is under 18.

  •  This form reproduced courtesy of The International Center for Reiki Training.

    Used with permission.

  • Should be Empty: