Reiki Long Distance Questionnaire for Clients

With my signature below. I confirm that I have read and accurately

completed the above information to the best of my knowledge. I agree

to notify my Reiki Practitioner of any other relevant information that

may affect my treatment, including any changes to the information

above. I agree to communicate with my Reiki Practitioner about any

pain or discomfort experienced during or after the procedure. I

understand that a Reiki session is not a substitute for medical or

psychological diagnosis and treatment. I acknowledge that long term

imbalances in the body sometimes require multiple sessions to

facilitate the level of relaxation needed by the body to heal itself. I

understand that it is recommended that I see a licensed physician or

licensed health care professional for any physical or psychological

condition I may have. I release my Reiki Practitioner of all liability for

injury or damages that may arise because I have not represented my

medical history accurately.