Reiki Health PAR-Q 1

Birthday

Month

Day

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

Jikiden Reiki is a hands on treatment do you consent to this? (hands are placed over clothing, there is no need to remove any clothing)

Yes

Are you pregnant?

Yes

Are you taking any prescribed medication? If yes please give details.

Are you currently receiving any treatment from a GP/health professional?

What is the reason for your visit?

TERMS & CONDITIONS

Reiki is safe treatment with no known contraindications but as with all forms of healing, it is prudent to consult your doctor before starting reiki sessions if you have any health concerns.

These sessions are not a substitute for medical counselling or treatment.

If you have any doubts about the suitability of this treatment, you should refer back to your medical practitioner.

The practitioner can accept no liability for personal injury related to participation in a session if:

• Your doctor has, on health grounds, advised you against such treatment.

• You fail to observe instructions on safety or technique.

Please inform your practitioner immediately if you feel any

discomfort during a session.

Disclosure

I have read, understood and accurately completed this form.

I confirm that I am voluntarily engaging in a Reiki treatment.

Having answered YES to any questions above, I have sought medical

advice and my GP has agreed that I can receive Reiki treatment at my own risk.

By attending any Asana & Aura, I consent to take full responsibility for my own wellbeing and injury and I remove all responsibility from Asana & Aura and partners.

Confirm you have read, understand and agree to the Terms and conditions.

Yes