Reiki Waiver

Reiki Client Information Form

Reiki Client Information Form

Please complete the following intake form at least 24 hours before your scheduled appointment in order to receive a Reiki treatment.
Are you Pregnant?
Are you currently under the care of a physician?
Have you ever had a Reiki session before?
Are you sensitive to perfumes or fragrances?
Is it ok for Melissa to use essential oils?
Are you ok with gentle touch during the session?
Is it ok for Melissa to place her hands on your head, shoulders, knees and feet?

*** Before your session, please read over and check each paragraph that you understand and agree. ***

I understand that Reiki 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 ailment 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.

Having read, completed and understood the foregoing, I request to receive Reiki treatment. I understand that Melissa is providing Reiki treatment for me at my request and is not responsible for the outcome of the Reiki session. I agree to hold Melissa Braun and SoulFull Co. harmless for any intended or unintended result.

Signature of Guardian if client is under the age of 18.

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. If you request to release any information, please list the contacts information and their relation to you below.

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