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Home
About Us
Our Services
Reiki Energy
Spiritual Companionship
Testimonials
Contact Us
Code of Ethics
Privacy Policy
Terms of Service
X
Reiki Client Information Form
Name
Phone
Is Texting Ok?
Yes
No
Address:
City, State, Zip:
Email
Emergency Contact (name/phone)
How did you hear about Healing Arts, LLC?
Have you had Reiki before?
If so, how long ago was your last session?
If yes, number of previous sessions:
Do you have a particular area of concern?
Are you sensitive to perfumes, fragrances, or essential oils?
Yes
No
Are you sensitive to touch?
Yes
No
I understand that Reiki is a simple, gentle, hands-on energy technique that is 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 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, 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.
Signature
Date
Privacy Notice: No information about any client will be discussed or shared with any third party without written consent of the client or parent/guardian if the client is under 18.
Healing Arts LLC, 410 State St., Suite 5, North Haven, CT. 06473
reiki@healingarts.biz ||
https://healingarts.biz
|| 203.800.2149
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