CLIENT INTAKE & CONSENT FORM

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Have you experienced Reiki or Quantum Healing with Reiki before? *

No

Yes, Reiki

Yes, Quantum Healing with Reiki

How did you hear about us? *

I'm already an Arawa Moon Customer

Friend/Family recommendation

Instagram

Tik Tok

Facebook

Google/Search Engine

I understand that the Quantum Healing with Reiki session(s) scheduled for myself, is intended to provide relaxation, reduce stress, promote overall health and well-being. I understand that Quantum Reiki practitioners do not diagnose conditions, prescribe medication, perform medical treatments of any kind or interfere with the treatment of a licensed medical practitioner or other medical professionals. I understand that Reiki practitioners do not heal, but act as conduits to allow energies to enter my body physically and ethereally to assist in healing. I understand that Reiki is not a substitute for medical care or medicine and that I may need to receive permission from my medical practitioner in order to request Reiki sessions. I understand that the session is totally voluntary, and I may choose to end the session at any time. I understand that my safety and care are ultimately my own personal responsibility. I understand that Reiki can complement medical care that I may be receiving. I agree that I will inform my practitioner of any significant health changes prior to future appointments. I also understand the body has the ability to heal itself and to do so, complete relaxation is beneficial. I acknowledge that long-term imbalances may sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. I understand that Quantum Reiki practitioners are providing Quantum Healing with Reiki at my request and are not responsible for the outcome of the session. I understand that I have not received any guarantee of outcomes or success that I will receive from Reiki therapies provided. *

Yes, I understand the above

By ticking the checkbox below, I confirm that I have completed and understood this form to the best of my ability. I acknowledge full responsibility on requesting this Reiki therapy session. I waiver any and all responsibility and liability to my practitioner for any situation that may arise that I may have felt could have been attributed to this healing session. *

I agree and authorise Desreen Alexa to provide me Quantum Healing with Reiki therapies.