Mia X Marks the Spot
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Waiver
Please fill out before services rendered.
Reiki/Energy Client Information & Waiver
Date
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Name
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Last
Phone
Email
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May we email you about future events and/or services?
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Medical Waiver – Please read and check each box after understanding and agreeing to each of the statements listed below:
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I understand that Reiki practitioners and herbalists 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 and herbalism 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.
Reiki Waiver – Please read and check each box after understanding and agreeing to each of the statements listed below:
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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.
Energy Work / Reading Disclosure – Please read and check the box below after understanding and agreeing to each of the statements listed below:
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All energetic/spiritual/shamanic readings of any type are for entertainment purposes only.
Practitioner is not a medical or legal advisor and readings in no way constitute and/or replace legal, financial, medical or any other professional advice.
License Disclosure – Please read and check the box below after understanding and agreeing to the statement:
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Practitioner is a certified Reiki Master and herbalist and not a licensed physician. Treatment is alternative to healing arts services and what is provided is not licensed by the state.
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