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Waiver for Reiki
Below please find the necessary waiver for attending one of my reiki sessions at any of the locations where I offer it, including your home. You can either copy the waiver and bring it already signed or I will have you fill it out upon your arrival. If under the age of 18, I will need a parent signature. This waiver is only needed once per client regardless of location(s).
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Reiki Client Information Form/Waiver
Name: (Please Print) ___________________________________________________________________
Phone (Home): _____________________________ Cell phone: ________________________________
Address: ____________________________________________________________________________
City, State, Zip:________________________________________________________________________
Email: ______________________________________________________________________________
Birthday : _________________
Have you ever had a Reiki session before? __Yes __No If yes, when was your last session? __________
Do you have a particular area of concern? __________________________________________________
____________________________________________________________________________________
Is it okay for me to use essential oils? ____________________
Is it okay for me to place my hands on your head, shoulders, knees and/or feet? _________________
The following Release and Liability Waiver is effective for all visits.
I understand that Reiki is a gentle, hands-on energy technique used for stress reduction and 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 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 or licensed health care professional for any physical or psychological aliment 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 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 assume sole responsibility for my own health and for the results of any sessions provided by Sandra Coyner that may affect my health in any way. Treatment/s will not replace conventional medical diagnosis or treatment. I will continue taking medication prescribed by a licensed medical physician and will continue to follow his/her instructions. I release Sandra Coyner from all legal liability during my participation in the Reiki treatment/s, as well as the locations where Sandra Coyner offers Reiki: Healing Arts Metaphysical, Naperville Salt Cave, her home in Aurora.
All information received by me from Sandra Coyner is accepted with full knowledge that any action taken by me as a result of the information received is my complete responsibility.
Signed: _______________________________ Date: _________________
Name: (Please Print) ___________________________________________________________________
Phone (Home): _____________________________ Cell phone: ________________________________
Address: ____________________________________________________________________________
City, State, Zip:________________________________________________________________________
Email: ______________________________________________________________________________
Birthday : _________________
Have you ever had a Reiki session before? __Yes __No If yes, when was your last session? __________
Do you have a particular area of concern? __________________________________________________
____________________________________________________________________________________
Is it okay for me to use essential oils? ____________________
Is it okay for me to place my hands on your head, shoulders, knees and/or feet? _________________
The following Release and Liability Waiver is effective for all visits.
I understand that Reiki is a gentle, hands-on energy technique used for stress reduction and 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 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 or licensed health care professional for any physical or psychological aliment 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 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 assume sole responsibility for my own health and for the results of any sessions provided by Sandra Coyner that may affect my health in any way. Treatment/s will not replace conventional medical diagnosis or treatment. I will continue taking medication prescribed by a licensed medical physician and will continue to follow his/her instructions. I release Sandra Coyner from all legal liability during my participation in the Reiki treatment/s, as well as the locations where Sandra Coyner offers Reiki: Healing Arts Metaphysical, Naperville Salt Cave, her home in Aurora.
All information received by me from Sandra Coyner is accepted with full knowledge that any action taken by me as a result of the information received is my complete responsibility.
Signed: _______________________________ Date: _________________