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Reiki Waiver Form
Full Name *
Email Address *
Cell Phone Number *
Are you currently under the care of a physician?
List of current medications and dosage - If any
How did you hear about Reiki therapy at Advanced Holistic Health?
Have you ever had a Reiki session before?
Clear selection
Do you have any areas of concern?
Privacy Notice: No information about any client will ever be discussed or shared with any third party without written consent. I understand that Reiki is a Japanese form of relaxation. A simple, gentle, energy technique that is alleviating stress, pain management, and deep 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 given by a licensed medical professional. 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 also 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 the practitioner will be remotely sending energy to me for the duration of my Reiki session(s) *
Today's Date *
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