Medical Waiver Form- Reiki Drumming
Please complete the following medical waiver form. Please note that because of imagery content often induced by the Reiki sacred drumming, it is not recommended for anyone who has experienced schizophrenia, severe emotional disorders, hallucination problems or psychosis or another severe mental disorder in the past 2 years (but Reiki without the drumming is fine). If you are unsure please consult your doctor. Due to the nature of the work and the sacred space please refrain from drugs (excluding medication) for 72 hours beforehand and alcohol 24 hours before. 18 years and over only. Not recommended for those in first trimester of pregnancy. Due to drumming being known to effect the heart beat, if you have heart disease/ condition or a pacemaker, drumming may not be suitable for you. If unsure please consult your doctor beforehand.
Participant's Full Name
*
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date
Phone Number
*
Email
example@example.com
Are you pregnant
Yes
No
Medical Condition(s), allergies, and medications
*
Present ailments
Recent surgeries
Please note we will be inviting you to self anoint with Rose Essential oil with Almond oil carrier. Please feel free to email before if you have allergies or sensitive skin or you can patch test on arrival (ask Megan) or not use the oil but with self anoint water.
Read
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I hereby agree, that the above is true to the best of my knowledge and that the following treatment is given to aid in stress reduction and relaxation and therefore allow the body to heal. I also agree that I have been advised to obtain a medical opinion should my symptoms continue or I fall under a category stated above. I am fit for a Reiki drumming session.
Participant's Signature
*
Would you like me to send you emails about my work and upcoming events?
Yes
No
Consent to photos being taken for social media
Yes
No
Submit
Submit
Should be Empty: