APS Reiki Treatment Disclaimer/Waiver Form Please enable JavaScript in your browser to complete this form.Today's Date *Name *FirstLastAddress *City *State *Zip *Cell *Email *Reiki/Energy Healing Benefits:Relax you when you are sressedIncrease the vibrational frequency of your bodyBring about deep relaxationCenter your thoughts when you are confusedCalms you when you are frightenedEnergized you when you feel drainedHelp relieve painHelp accelerate the natural healing of woundsHelp to improve your healthGradually clear up chronic problemsHelp prevent the development of diseaseDetoxify the bodyDissolves energy blockagesRelease emotional woundsHave you ever had a Reiki/Energy Healing session before?YesNoIf Yes, when was your last Reiki/Energy Healing session?How often were your Reiki/Energy Healing sessions?Do you have a particular area of concern?Are you sensitive to perfumes or fragrances?YesNoAre you sensitive to touch?YesNoDISCLAIMER/WAIVER: I understand that Reiki/Energy Healing 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 aliment 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.Yes. I completely understand and I accept.I have indicated that I have read the DISCLAIMER/WAIVER above, and I fully understand the contents and typing my full name below will act as my "Signature" of signing this document.* 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.Submit
