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Reiki
Client Consultation Form
Caution Check (please select which is applicable to you):
Acute Undiagnosed Pain
Cardiovascular Condition
Allergies
Varicose Veins/Phlebitis
Diabetes
Imminent Medical Tests/Procedures
Epilepsy
Recent Surgery
Osteoporosis
Injury to the Feet or Foot Condition
None of the Above
Was it on time?
Yes
No
What was the flow like:
Light
Medium
Heavy
Are you pregnant or trying to conceive?
Pregnant
TTC
Perimenopause or Menopause
Perimenopause
Menopause
n/a
I am pregnant or trying to conceive. I have discussed the possibility of miscarriage and have been advised by the practitioner that there is no evidence to suggest that having Reiki can provoke a miscarriage, and I am willing to go ahead with the treatment at my own risk.
I declare the information in this form to be true, and accept that it is my responsibility to keep my practitioner updated regarding any changes in my health or medication. I am happy to receive Reiki and any other therapies as listed above. (You will be presented with a copy of this consultation form, for your signature, at your appointment)
I understand that Reiki Practitioners do not claim to cure, diagnose or prescribe, and that Reiki should not be used as an alternative to seeking medical advice. Always consult your medical professional/GP.
I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. 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.
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Thank you! I look forward to seeing you soon!
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