New Client Intake Form

In order to communicate regarding your sessions, your email address will be added to my subscriber/client list & only used in accordance with all spam regulations & nice-person values, i.e. your privacy is important to me & your data will NOT be shared with third parties. You can unsubscribe at any time via my emails. You can also ask for your information to be deleted. Please indicate your acceptance of these terms, or choose cancel to exit the form and not continue.

I understand that the Reiki I receive is provided for the basic purpose of relaxation and relief of tension and stress. If I experience any pain or discomfort during this session (in-person sessions), I will immediately inform the therapist so that adjustments can be made for my level of comfort. I further understand that Reiki should not be construed as a substitute for medical examination, diagnosis, or treatment, and that I should see a doctor or other qualified medical specialist for any physical or mental ailment that I am aware of. I understand that Reiki therapists are not qualified to diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the therapist’s part should I fail to do so. Please indicate your acceptance of these terms, or choose cancel to exit the form and not continue.