REIKI CONSENT FORM

NAME

First Name

Last Name

HAVE YOU HAD A REIKI BEFORE?

YES

NO

*

I understand that Reiki is not intended to replace regular medical treatment, medical advice, or make a diagnosis. If you are having symptoms of illness or issues of any nature, please seek medical attention. By signing this form you waive, Penny Dunn, practitioner from the liability of any pre-existing physical, mental, emotional, or spiritual condition you may have or anything you may experience during or after the session. No information about a client will be discussed or shared with any third party without written consent. In attending this session I confirm that I am feeling well and not displaying flu-like symptoms.

I ACCEPT

Please keep me updated on future wellness events & reiki courses

YES

NO, THANK YOU