Reiki with KC – Consent and Disclosure Form

About Reiki: Reiki is a gentle, complementary energy healing practice. During a session, the Practitioner may lightly place hands on or hold hands slightly above the body in a series of positions (such as the head, shoulders, arms, hands, torso, legs, and feet). Reiki does not involve massage, deep tissue work, manipulation of muscles or joints, or any invasive technique.

Not a Substitute for Medical Care: Reiki is a complementary wellness practice and is not a substitute for medical or psychiatric diagnosis and treatment. Clients are advised to continue care with licensed medical providers and follow their recommendations.

Practitioner Role and Scope: The practitioner is an RN, but Reiki is offered independently of that license and is not medical or nursing care. No diagnosis, prescription, or medical treatment is provided.

Touch and Boundaries: The client may choose light, hands-on touch or hands-hovering only. Touch is non-invasive and limited to typical areas (head, shoulders, arms, hands, torso, legs, feet). The client may pause or stop the session at any time and request areas to avoid.

Health Information and Safety: Clients should disclose relevant health conditions, injuries, or concerns. Reiki is generally gentle, but this information supports comfort and safety.

Possible Experiences and Outcomes: Experiences may include relaxation, warmth, tingling, emotional release, etc. Results vary; no specific outcome is guaranteed. Reiki supports well-being.

Acknowledgment and Consent: By signing, the client acknowledges reading and understanding this information, has had the opportunity to ask questions, understands Reiki’s nature and limits, and voluntarily consents to receive Reiki sessions under these terms.

If you have any questions about this form or Reiki sessions, please contact KC: Email: [reikiwithkc@gmail.com] Phone: [314-971-6414]