Consent Form

10

April, 2018

Please read the web version of the consent form below.

I understand that the services provided by Northern Virginia Reiki is intended to enhance relaxation and increase communication within my body.

I understand that these services are not a substitute for medical treatment or medications. I am aware that diagnosis is not given and medication is not prescribed.  I agree to continue to have regular medical check-ups as part of my overall health care plan.

I understand that participation is voluntary and that at all times I may choose to end my participation.  I understand that I may experience ‘healing reactions’ during the 24 to 48 hours following the services provided.

I understand that any information exchanged during any session is educational in nature and is to be used at my own discretion. I also understand that any information imparted during these sessions is strictly confidential in nature and will not be shared with anyone without my written permission. I do, however, give the practitioner consent to use my case history and results without using my name.  I understand that only Northern Virginia Reiki will have access to information in my file to enhance my healing.

I understand that by providing this informed consent I am assuming full responsibility for my services and I hold harmless Northern Virginia Reiki.

I agree to the terms and conditions set out by this consent form and certify that the above information is true and correct.  I agree to pay for distance sessions, should I request them.

You can download a copy and sign it before your session or you can sign it upon my arrival. 

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