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Reiki Intake Form & Consent

Thank you for booking your Reiki session with me! I'm honored to support you on your healing journey.

This form is intended to help me better understand how to best support you and also serves as an acknowledgement of what Reiki is (and isn't), along with a simple release of liability. Please answer the questions below with as much honesty and comfort as you feel ready to share.

All information you share is kept confidential and meant to create a safe, grounded and aligned experience for us both. If you have any questions or concerns, feel free to reach out. 

Type of Session Required
Text ok? Required
Are you sensitive to fragrance/scents? Required
Are you sensitive to sound? Required
Are you comfortable with laying on your back during your session (1 hr)? Required

Note: We are able to adjust the session so you will be sitting instead of laying down if needed. 

Gender Identification *
Have you had Reiki Session before? Required

Reiki Treatment Acknowledgement & Release Form

I understand that:

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1. Kristy Engelke is not a licensed physician; her services 1) are alternative or complementary to healing arts services licensed by the State of California, and 2) are not licensed by the State of California;

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2. Kristy Engelke Luminous Alchemy services are modeled after a reiki healing method developed by Mikao Usui;

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3. Usui Reiki is healing method based on the theory that 1) the practitioner is able to access universal life force energy for the benefit of the client; 2) this energy is plentiful and available to everyone; and 3) it is accessed through the intention to align with it;

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4. During a reiki session, Kristy Engelke will ask me to sit or lie comfortably while fully clothed; she will place her hands lightly on or just over me (either physically, during an in-person service, or over my energetic field during a distance service), and move them through a series of placements from my head to my feet;

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5. I will be guided through relaxation, visual imagery, and/or stress reduction techniques. I am aware these modalities are non-medical in nature and it is my responsibility to consult my regular doctor about any changes in my condition or changes in my medication;

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6. Reiki is not a substitute for regular medical care and I have been advised to consult my regular medical doctor or health-care practitioner for treatment of any old, new or existing medical conditions;

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7. 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; and 

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8. Reiki services can complement any medical or psychological care I may be receiving; they do not take the place of medical care, and it is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment. 

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9. I take responsibility for receiving Kristy Engelke's services and release her from responsibility for any mental, emotional, or physical changes which may or may not occur after receiving her services. 

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10. No information about me will be discussed or shared with any third party without my written consent (or the written consent of my parent/guardian if I am under the age of 18). 

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By signing electronically, I accept the terms and conditions of the Reiki Treatment Acknowledgement & Release Form and I confirm that my information is accurate and true.

Thanks for submitting!

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