Name *

First Name

Last Name

DOB *

MM

DD

YYYY

Phone *

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I, the undersigned, understand that Reiki session/training given involves natural hands on method of energy balancing for the purpose of pain management, stress reduction, and relaxation.

Yes

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I understand very clearly that these treatments are not intended as a substitute for medical or psychological care.

Yes

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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 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.

Yes

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I am in good general overall health and feel physically capable and ready to engage in physical movement. I recognize the possible risks and the chance of injury and illness involved in any physical exercise and hereby take responsibility for determining my own level of participation and take full responsibility for my own health and safety. I furthermore recognize that meeting in person for Reiki instruction and yoga movements could increase my chances of contracting an illness including but not limited to the coronavirus. By clicking Yes on this form, I agree to not to hold Erika Tran responsible for any injuries that I may incur and/or any illnesses that I may contract including but not limited to coronavirus during my training.

Yes