Abigail Tamsi - abigailtamsi.com - Reiki Distant Healing Client Information Form
First Name *
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Surname *
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Email *
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Street Address *
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Phone Number *
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Are you the one who will be receiving the Reiki Distant Healing? *
What is the full name of the person who will be receiving Reiki Distant Healing? *
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What is your relationship with the person who will be receiving Reiki Distant Healing? *
Do you have verbal, written or expressed permission from the person who will be receiving the Reiki Distant Healing to request healing on their behalf? Please note, it is against this practice’s ethics to provide healing to anyone who has not provided consent. If the person to be given distant healing is unable to provide express consent (e.g. in a coma), I will be getting in touch with his/her soul prior to the healing to find out whether they agree with the request for healing made on their behalf. *
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Why is Distant Healing being requested? Please provide as much detail as you are comfortable sharing. *
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Is the person who will be receiving the Reiki Distant Healing currently under the care of a physician? *
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Please provide details of any medications (and dosages) currently being taken by the person who will receive Distant Healing. *
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Please describe any particular areas of concern of the person who will receive Distant Healing. *
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Has the person who will be receiving the Reiki Distant Healing had a prior Reiki session? *
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How many Reiki sessions have you or the person who will be given the Distant Healing received previously? *
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When was the most recent Reiki session received by yourself or the person who will be given Distant Healing? *
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What is your preferred date to receive Reiki Distant Healing? *
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Please provide a date and time in AEDT: evenings on Mondays-Fridays or daytime on Saturdays-Sundays for the Reiki Distant Healing to be provided. It is recommended that the person is in a restful state, i.e., not engaged in any activity, during Reiki Distant Healing. Optional: Please send a photo of the person to be given distant healing to abi@abigailtamsi.com . *
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Informed Consent:  I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation.  I understand that my consultation may provide benefits for certain conditions but results are not guaranteed. These benefits may include tension relief, relaxation, reduction in the symptoms of stress-related conditions, amplified energy, increased creativity, balanced energy, and improved general wellbeing. I also understand that my consultation may help facilitate emotional release and increased awareness.  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 healthcare professional for any physical or psychological ailment I may have. This also applies if the person I’ve requested distant healing for is not myself.  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.  I understand that Reiki does not change people or their behaviours, and that Reiki always works with the best possible outcome that is unknown to Reiki practitioners or me. *
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Please type your full name below to confirm you are providing informed consent to request Reiki Distant Healing. *
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Please choose the current date to confirm you are providing informed consent to request Reiki Distant Healing. *
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How did you hear about us? *
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Privacy Policy: Abigail Tamsi/Wisdom of SelfLove Pathway and Services is committed to the privacy of clients. Personal information istreated as confidential and is used only for the purpose for which it was collected. Information kept on file will not be released to a third party without the express consent of the client or as required by law. 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. Have you read our Privacy Policy? *
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