Registration Form

First Name

Last Name

Cell Phone

Address

City

State

How did you hear about us?

Do you have a particular area of concern?

You can attach a recent photo for energy diagnostics (full body from head to toes) or other information

I understand that Reiki is a gentle, hands-on or hands-off energy technique that is used for stress reduction and relaxation. A treatment feels like a glowing radiance that flows through your body and around you. I understand that Reiki can complement any medical or psychological care. 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. It takes four treatments to open the pathways through which Reiki flows within your energy system and experience maximum benefit.

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 for any physical or psychological ailment I may have. I accept the refund policy terms and conditions.

Any personal information or discussions shared during the Reiki sessions will be treated with utmost confidentiality. Your privacy will be respected, and no information will be disclosed to third parties without your explicit consent, except as required by law.

By signing below, I acknowledge and fully agree with the above information.

E-Signature (Full Name)

Date

Useful links

our services

Subscribe to newsletter