• Reiki Energy Healing Intake Form

    All information is held confident. At no given point is information disclosed or shared without client’s written consent. 
    Reiki Energy Healing Intake Form
  • Health Information

    This information is relevant to your session
  • Session Experience

    Before we begin we will take 5 - 10 minutes to check in and save time at the end to discuss
  • Please check any that apply:

  • Client information are confidential and written authorization is required to release any information.

    Please reschedule session if more than 15 minutes late

    24 hour cancellation notice is required 

    You will wear clothing before, during, and after your session while the reiki practicioner is present

    You will have a consultation prior to the session if this is your first visit

    You may end the session at any time for any reason

    You may bring crystals and other objects you would like to attach energy to or cleanse and/or a journal to record anything that comes up in your session

    Inappropriate behavior will not be tolerated and may be prosecuted to the full extent of the law


    Client Agreement:

    I, the undersigned, hereby acknowledge that I am voluntarily participating in Reiki sessions provided by Inner Oasis, LLC. I understand that Reiki is a simple, gentle, hands-on energy technique used for stress reduction and relaxation. I acknowledge that:

    No Medical Claims: Reiki practitioners do not diagnose conditions, prescribe medication, or perform medical treatments. Reiki is not a substitute for medical or psychological diagnosis and treatment.

    Personal Responsibility: I understand that it is my responsibility to consult with my healthcare provider regarding any health concerns or conditions I may have. I acknowledge that Reiki may complement any medical or psychological care I am receiving.

    Voluntary Participation: My participation in Reiki sessions is voluntary, and I may discontinue at any time. I understand that I have the right to refuse any aspect of the treatment.

    Informed Consent: I have been informed about the nature of Reiki and the procedures involved. I understand that Reiki involves a light touch or no touch at all, and that I may experience feelings of warmth, coolness, or tingling.

    Release of Liability: I hereby release Inner Oasis, LLC, its practitioners, employees, and agents from any and all liability, claims, or demands arising from or related to my participation in Reiki sessions. This release includes, but is not limited to, any claims of injury, illness, or damages.

    Confidentiality: I understand that my personal information and the details of my Reiki sessions will be kept confidential and will not be disclosed without my written consent, except as required by law.

    Acknowledgement:
    By signing below, I acknowledge that I have read and fully understand the contents of this waiver and release form. I agree to the terms and conditions stated above and voluntarily seek Reiki services with full knowledge of the risks and benefits.

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