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Reiki Client Information and Consent Form

Are you currently receiving treatment from a doctor?
Are you currently taking any medications
Is there any possibility that you may be pregnant?

* NB there are no known contra indications with Reiki and pregnancy, however extra care needs to be taken within the first 3 months of pregnancy.  Please advise and record if there has been any health concerns.

Have you ever had Reiki before?
Are you allergic or sensitive to perfumes, fragrances or nuts?
Would you like to be on my mailing list?

Please read and sign if you agree.  As this is an electronic form, your printed name below will be accepted as your consent.

I understand that Reiki is a simple, gentle, hands-on/off energy technique that is used for stress reduction, relaxation and self healing. 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 doctor or 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, 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 hereby give my consent to receiving Reiki both online and face to face and I am happy for you to retain my records under GDPR.

Thank you for submitting your consent form

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