Below please find the necessary waiver for attending one of my reiki sessions.
Reiki Client Information Form/Waiver
Name: (Please Print) ___________________________________________________________________
Phone (Home): _____________________________ Cell phone: ________________________________
City, State, Zip:________________________________________________________________________
Birthday : _________________
Have you ever had a Reiki session before? __Yes __No If yes, when was your last session? __________
Do you have a particular area of concern? __________________________________________________
Is it okay for me to use essential oils? ____________________
Is it okay for me to place my hands on your head, shoulders, knees and/or feet? _________________
The following Release and Liability Waiver is effective for all visits.
I understand that Reiki is a gentle, hands-on energy technique 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 aliment 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.
I assume sole responsibility for my own health and for the results of any sessions provided by Andrey Cornejo that may affect my health in any way. Treatment/s will not replace conventional medical diagnosis or treatment. I will continue taking medication prescribed by a licensed medical physician and will continue to follow his/her instructions. I release Andrey Cornejo from all legal liability during my participation in the Reiki treatment/s, as well as the locations where Andrey Cornejo offers Reiki: Natural Healing Bradenton, 5705 Fishermans Dr, his home in Bradenton, Florida.
All information received by me from Andrey Cornejo is accepted with full knowledge that any action taken by me as a result of the information received is my complete responsibility.
Signed: _______________________________ Date: _________________