In-Person Reiki New Client Form - Peace Bridge Reiki

IN-PERSON REIKI CLIENT FORM & DISCLOSURE AGREEMENT

Name(Required)

First Last

Phone(Required)

Email(Required)

Client Preferences

Do you prefer the use of incense?

Do you prefer the use of essential oils?

For in-person Reiki, hands are placed on or near the body in non-intrusive areas. Do you prefer hands on or above your body?

Please share more information about any sensitivities or preferences to make you most comfortable for your session(Required)

In receiving Reiki in a session - also referred to as ‘sharing Reiki’ - from Peace Bridge Reiki LLC, I understand that Reiki is a non-invasive system of natural healing that is provided both at a distance (remotely) and in-person by its practitioners. I give my permission to receive Reiki during the session. Reiki is commonly identified for relief of stress reduction, relaxation and pain. Peace Bridge Reiki LLC abides and upholds a Code of Ethics which I can read here: https://peacebridgereiki.com/code-of-ethics/. Reiki sessions are offered by Peace Bridge Reiki LLC's practitioners who are neither licensed, certified, nor regulated by the state as health care professionals. Peace Bridge Reiki LLC does not diagnose conditions nor prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of any licensed medical professionals. Reiki complements medical or psychological care I may be receiving. I take full responsibility to see a licensed physician or a licensed healthcare professional for any physical or psychological ailment or condition as required, as I understand that Reiki does not take the place of medical care. Except in the case of gross negligence or malpractice, I and any of my representatives agree to fully release and hold harmless Peace Bridge Reiki LLC and its practitioners against any and all claims or liability whatsoever, kind or nature arising out of or in connection with my session(s). Peace Bridge Reiki LLC carries professional and general liability insurance. In the state of Colorado, SB 13-215 prohibits Peace Bridge Reiki LLC to offer Reiki to a child less than 2 years of age, and can only provide services to children ages 2-8 with written permission from a parent or legal guardian. I have been provided phone, address and contact information for Peace Bridge Reiki LLC, and have access to read about Michel Barta’s training credentials at https://peacebridgereiki.com/michel-barta/ . By entering my name below, I fully understand and acknowledge these terms & conditions without any questions or concerns.(Required)

Today's Date(Required)

Phone

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For any questions or additional information prior to your Reiki session, please contact Michel Barta at PeaceBridgeReiki@gmail.com.

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IN-PERSON REIKI CLIENT FORM & DISCLOSURE AGREEMENT

Client Preferences

Explaining Distance Reiki

Tips for Having Your Best Reiki Session Experience

Contact Michel Founder of Peace Bridge Reiki

I’d Like to Stay Connected Sign Me Up for for Blog Posts, New Services and Reiki Updates

Contact Michel
Founder of Peace Bridge Reiki

I’d Like to Stay Connected
Sign Me Up for for Blog Posts,
New Services and Reiki Updates