Reiki Consent Form
  • Reiki Consent Form

  • Client Information

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

  • Please answer the following questions to the best of your knowledge:

  • What is Reiki

    The Usui System of Reiki Healing is a palms-on healing practice. Reiki is an ancient laying-on-of-palms healing technique that uses the Universal life force energy to balance the subtle energies within our bodies and to heal. Reiki practitioners act as a conduit or channel through which Reiki energy travels. The intended result of receiving Reiki is a balanced physical, mental, emotional, and spiritual being. Reiki is being used today in clinics and hospitals all over the world to support health, wellness and transition.

    Disclaimer

    Reiki is NOT a substitute for traditional medical treatment and CANNOT cure any medical conditions. Reiki practitioners are NOT licensed medical professionals and I will never diagnose you with any medical conditions, prescribe substances, or perform medical treatment of any kind. Reiki is a complementary treatment that is to be used alongside traditional medical treatment under the supervision of licensed medical professionals. As a complementary or alternative medicine, Reiki owes not require licensing by the state of California. 

    Qualifications

    Alice Lee has been practicing Reiki since 2020 and received her Level III Attunment (Reiki Master Teacher Certification) in 2021. She was taught privately by Reiki Master Teacher Jenny Wright in San Diego, CA. She opened her first clinic Hibiscus Healing in Banker’s Hill soon after. Alice is a volunteer with Bristol Hospice where she provides Reiki for patients in hospice care. She is also an associate member of the International Association of Reiki Professionals.

    California 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 health care 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, the patient?

    SB 577 provides you with access to alternative and complementary health care practitioners. You must be given information about the nature of treatment and practitioner’s qualifications. Feel free to ask a practitioner any question you might have about your 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 health care practitioners to follow certain guidelines and restrictions. Here are the things that unlicensed alternative practitioners are not allowed to do:

    Perform any form of surgery or any procedure that punctures your 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 you at risk of great bodily harm, serious physical or mental illness, or death.
    Imply in any way that they are licensed physicians.
    In addition, all unlicensed alternative practitioners must do the following to comply with the law:

    Provide you with a statement, written in plain language, that includes the following information: 

    (a)  That he or she is not a licensed physician and that his or her services are not licensed by the state. 

    (b) A brief clear description of the kind of services he or she provides and the reasoning behind it. 

    (c) A description of his or her education, training, and experience.

    Ask you to sign an acknowledgment 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 acknowledgment for three (3) years.

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