top of page

First Time Clients...

If this is your first session with me, please fill out the following form. 

Not a first time client? No need to fill this form out twice! 

Disclosure & Consent Form

Confidentiality Statement: No information shared in our session will be discussed or shared with anyone else without your written consent or consent of your parent/guardian (for clients under 18). However, if your safety or the safety of someone else is at risk, I may contact emergency personnel.
Reiki Disclosure: 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.

Thank you! Your response has been received.

bottom of page