Biota in Harmony - Reiki Healing Consent | Acknowledgement Form Name * First Name Last Name Date of Birth * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Contact Number * (###) ### #### Support / Emergency Contact Name + Mobile Number Email * How did you hear about Biota? Do you have particular areas of concern? Checkbox * I confirm that the answers given are correct and that I have not withheld any information that may be relevant to my treatment. I understand that all treatments given are for general wellness purposes and that I should see a doctor or other appropriate health care provider for diagnosis and treatment of any suspected medical conditions. It is my responsibility to keep my therapist informed of any changes in my health or medication taken. I acknowledge that Reiki is a Japanese form of relaxation. A simple, gentle, energy technique that is used for alleviating stress, pain management, stress reduction and deep relaxation. I understand that Reiki can complement any medical or psychological care I may be receiving. I understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. I understand that the practitioner will be sending energy to me for the duration of my Reiki session(s). Date MM DD YYYY Signature / Name * Thank you! We look forward to welcoming you for your Reiki session at Biota.
