Minor Consent Form Minor Consent Form Name * Name First First Last Last Email * Phone * D.O.B. * Emergency Contact * Have you had a Reiki session before? * Yes No If yes, when was your last session? How did you hear about my service? * Are you sensitive to fragrance? * Yes No What brings you in today? * I, ____________, understand that a Reiki session is a spiritual treatment to heal the energy within you and increase your awareness of the communication within your body. A Reiki session is not a substitute for medical or psychological diagnosis or treatment. Reiki practitioners do not diagnose conditions, prescribe or perform medical treatment, or interfere with the treatment of a licensed medical professional. I understand that my participation in this session is voluntary and that at any time I may choose to end my participation. I further understand the healing reactions I experience today may only last 24-48 hours depending on choices I make after this session. By executing this consent, I am assuming full responsibility for my services, and I hold harmless both the practitioner of Blissfully Divine Healing, L.L.C. and the facility of Beautiful Soul where the services are provided. * E- Signature of the Guardian of a Minor Client * Clear I require that the Guardian of the client stay in the room during the Reiki session of a minor under the age of 19 years old. Today's Date * If you are human, leave this field blank. Submit
