Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Physical Address *

This is helpful for channeling.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is this also your Mailing Address? Occasionally, I will send out gifts. *

yes

no

Phone *

For international clients who prefer sessions by phone, we will be using WhatsApp.

Country

(###)

###

####

I was referred by:

Both you and the client who referred you will receive a free spot in my next virtual Reiki Class as a thank you. Book with promo code REFERRAL.

First Name

Last Name

Are you comfortable with decks like tarot cards or oracle cards? *

yes

no

Are you comfortable with crystals? *

yes

no

Name *

First Name

Last Name

Emergency Contact Phone *

Country

(###)

###

####

Consent to Receive Services *

To utilize my services, California state law mandates signing and acknowledging receipt of the information in this form. Please note, my services are not directly governed by the State of California; they represent an alternative or complementary approach to healing arts services licensed by the state under Sections 2053.5 and 2053.6 of California’s Business and Professions Code. I understand that Reiki is a gentle energy healing technique, administered through hands-on or hands-off methods. This treatment operates on the theory that symptoms may have physical, emotional, or energetic origins. My Reiki Master Practitioner will evaluate my biofield and utilize intuition, divine guidance, and/or energy work to help me address any disconnect and restore homeostasis. I understand that addressing long-term imbalances may require multiple sessions to facilitate the body's self-healing processes. I am aware that shifting energy may temporarily affect my biofield, and I acknowledge this as a natural occurrence. I take full responsibility for my own health and for any effects on my health resulting from sessions provided by my Practitioner. I recognize that Reiki can complement but cannot replace medical care, and that my Practitioner is not a licensed physician or therapist. I understand that Practitioners neither diagnose conditions nor prescribe or administer medical treatment, substances, or interfere with the treatment of licensed medical professionals. It's advised that I consult a licensed physician or healthcare professional for any physical, mental, or emotional ailments. I absolve my Reiki Master Practitioner from any legal liability during my engagement with her services. I understand that any information received is accepted with the understanding that any actions I take based on this information are entirely my responsibility. All disclosed information is confidential and cannot be shared with anyone without written permission, except when legally mandated. Disclosure may be necessary in cases of suspected child or elder abuse, when there's reasonable concern for the client's safety or the safety of others, or in relation to legal proceedings. I understand that my Practitioner may discuss my case with a colleague for a second opinion, ensuring my name remains undisclosed.

I have read and agree to all terms

Terms & Conditions *

I understand the services, rates, promotions, policies, and exceptions outlined on this website. I am aware that full payment is required at the time of booking, and that all services are conducted remotely or virtually. Cancellation Policy: As this is energy work, I work with a very limited number of clients each day so I can give 100% in every session. If possible, kindly give at least 24 hours’ notice if you need to reschedule or cancel. Refund Policy: All sales are final and non-refundable. Should you need to cancel or reschedule your appointment, your payment will remain in your account as a credit toward a future purchase.

I have read and agree to all terms