Pre-Teen and Teen Single Session

Name *

First Name

Last Name

Please Mark the box to consent *

I confirm that I am at least 18 years of age, or have parent/guardian permission

I have elected, by my own decision, to have a Reiki therapy session

I confirm that I am not under the influence of recreational drugs or alcohol.

The procedure, including the process and objective, has been explained to me before undergoing Reiki.

I understand that Reiki is a simple, gentle, hands-on energy technique used for stress reduction and relaxation.

I understand that a Reiki session is not a substitute for medical or psychological diagnosis and treatment. I also understand that it is not massage therapy.

I understand that 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 participation is voluntary and that at any time I may choose to end my participation.

I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level to relaxation needed by the body to heal itself

I have been given the opportunity to ask questions regarding any benefits, risks, or possible complications of the procedure.

I have followed all pre-treatment care instructions as they have been explained to me. I understand all aftercare procedures for Reiki as they've been explained, and I intend to adhere to the instructions given to me.

I understand that it is important to provide feedback during my treatment, and will inform my Reiki Practitioner of any pain or discomfort during the session.