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In-person Reiki intake form

Name
Have you experienced a Reiki session before?
During your Reiki session, hands are placed lightly on the body or hovered above ('hands off'). Please indicate your preference.
Note: Sensitive areas (abdomen, chest, pelvic area) are always treated with hands hovering.
Do you have any sensitivities to scents? Sessions may sometimes include sage, palo santo, incense or aromatherapy.
Do you have any sensitivities to noise or music? Sessions may sometimes include light frequency music, tuning forks, or sound bowls.
Would you like to recieve periodic email updates about Reiki and yoga offerings in Charleston?
Note: In-studio Reiki sessions are typically available on weekday evenings at 7 p.m., Saturday evenings after 4:30 p.m., or on Sundays. If these days/times do not work for you, distance Reiki may also be an option.
Reiki consent & release of liability
Reiki Consent & Release of Liability Form 1. Nature of the Session: I understand that Reiki is a gentle, non-invasive complementary energy practice. It is used for stress reduction, relaxation, and balancing the body’s energy systems. I understand that the practitioner may use light touch or place their hands slightly above my body. 2. Not Medical Care: I clearly understand that Reiki is not a substitute for medical or psychological diagnosis and treatment. Reiki practitioners do not diagnose conditions, prescribe substances, perform medical treatments, or interfere with treatments provided by a licensed healthcare professional. I acknowledge that I should consult a licensed physician for any physical or psychological ailment. 3. Assumption of Risk & Voluntary Participation: I understand that my participation in this session is entirely voluntary. I agree to assume full responsibility for any risks, known or unknown, associated with my participation. I hold the sole responsibility to inform the practitioner of any discomfort during the session or any pre-existing medical conditions. 4. Release of Liability: In consideration for receiving Reiki services, I hereby release and discharge LeeAnn Neumann, OM Tide, its owners, and its practitioners from any and all claims, demands, or causes of action for damages or injuries that may arise from my participation, including claims of malpractice, negligence, or lack of informed consent. 5. Confidentiality: I understand that all information and records regarding my session will be kept confidential unless I provide written consent to release them. 6. Acknowledgement: By checking the box above, I certify that I have read this form carefully, fully understand its terms, and am signing voluntarily.