Healing Services Client Intake Form and Waiver

Healing Services Intake Form and Waiver

* Indicates required field

Name *

First

Last

Email *

Address *

City, State, Zip *

Phone Number *

Current Medications and Dosage *

Have you ever had a Reiki/Pranic/Massage/Thai Therapy Session before? *

Do you have a particular area of concern? *

WAIVER: I understand that Reiki, Pranic Healing, Massage and Thai Yoga Therapy is a gentle hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki, Pranic and Healing Arts Practioners 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, Pranic Healing, Massage or Thai Yoga Therapy 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, Pranic Healing, Massage and Thai Yoga Therapy can compliment 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.

Signature *

Date *

Submit

Healing Services Intake Form and Waiver

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