Resilience Reiki, LLC
Services Agreement and Consent Form
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PLEASE READ THE FOLLOWING CLIENT INFORMATION
What is Reiki?
Reiki is a Japanese technique for stress reduction and relaxation that also promotes healing. It is administered by utilizing healing touch and is based on the idea that an unseen "life force energy" flows through us and is what causes us to be alive. If one's life force energy is low, then one is more likely to experience illness or stress. If it is high, one is more capable of feeling relaxed, happy and healthy.
Your Reiki Practitioner
April Unterberger, referred to in this contract as Resilience Reiki, LLC, is a certified Reiki Master with a Master’s degree in Social Work. She is trained by the International Center for Reiki Training. April is a Master level Reiki Practitioner operating under Oregon’s “educational licensing exemption” under ORS 675.825(4)(a), which allows alternative practitioners and counselors to practice legally in Oregon without a license.
Nature of the Treatment
Reiki utilizes the theory that light touch of the practitioner’s hands promotes energy balance, improving overall healing of the client. The client can expect to be fully clothed in a lying or sitting position and will experience light touch, if touch is consented to by the client. Through light touch, Reiki can help achieve emotional balance and inner peace. Reiki may help develop a stronger sense of self and improved mood balance. Results of Reiki may vary for individuals. Therefore, a specific outcome cannot be guaranteed by the Reiki Practitioner.
What Reiki is Not
Reiki is not psychology, psychiatry or medicine and the Reiki practitioner is not a licensed physician, psychologist, or psychiatrist. Reiki is intended to be a complement to traditional Western medicine provided by doctors, nurses, and other licensed medical professionals. If you believe you are ill, please see a licensed medical professional prior to beginning Reiki treatment.
Client certifies that they do not suffer from any physical or mental disability that may affect their participation in the services with the practitioner and if they have a mental or physical illness, they have consulted with their health care provider and have been advised they may participate in the services by the practitioner. Client agrees if there is any change in representation, the practitioner will be promptly advised. Client is responsible for creating and implementing their own physical, mental, and emotional well-being, decisions and results. Therefore, the client agrees that the practitioner is not and will not be liable for any actions or inactions or of any direct or indirect results of the services provided by the practitioner.
The practitioner makes no guarantees or warranties, expressed or implied. In no event will the practitioner be liable to the client for consequential or special damages. I, the client, agrees that in the event of any claim or grievance by me against the practitioner, my sole remedy will be the return of the fees paid. The practitioner is not responsible for any direct, indirect or incidental or consequential damages beyond the total amount of fees paid by the client.
ACKNOWLEDGEMENT & CONSENT TO RECEIVE SERVICES
I have read Client Information and understand the above guidelines and disclosure about the treatments and techniques offered by Resilience Reiki, LLC as well as her training and education.
I understand that Resilience Reiki, LLC is not a licensed physician and that the alternative services I will be receiving are not licensed nor required to be licensed in the State of Oregon.
I have discussed any concerns I have with the practitioner about the nature of the treatment I will be receiving.
I will immediately inform the practitioner if I experience any discomfort during the session(s).
I acknowledge that long-term imbalances in the body may require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.
I understand that it is my responsibility to maintain a relationship for myself and/or my child with a medical doctor.
I understand that Reiki is not a substitute for medical treatment or medications. I am aware that Resilience Reiki, LLC does not diagnose illness or disease nor does she prescribe medications or recommend supplements. I understand that any suggestions that are provided to me should not be taken as a diagnosis or recommendation against the advice of a licensed physician or mental health professional.
I have consented to use the services offered by Resilience Reiki, LLC and I agree to be personally responsible for her fees in connection with the services provided.
I understand Reiki healing consists of light on the body touch. By signing below, I agree to touch by the practitioner.
I understand I may be asked to work with the practitioner’s apprentice and will be notified of this before the session. If I do not choose to work with an apprentice, I will notify the practitioner immediately.
I understand if I cancel or reschedule my appointment with less than 24 hours notice, I will be charged 50% of the appointment/class/workshop fee.
I understand Resilience Reiki does not offer refunds.
Privacy Notice: No information about any client will be discussed or shared with any third party without written consent of the client or parent/guardian if the client is under 18.