Acknowledgment and Consent

 

Clients are requested to carefully review and sign the Acknowledgement and Consent form, indicating their understanding and agreement to its terms. You only need to sign this form for your first session; subsequent sessions will not require it, as your signature will be kept on file for three years. For your convenience, you can locate the signature link at the bottom of this page.

California Client Information Form, Acknowledgment and Consent to Receive Treatment (In accordance with California Senate  Bill SB-577)  

What is Reiki? Reiki is an ancient practice for gently and non-invasively directing energy via the palms of the hands. This important spiritual energy promotes the body's inherent healing processes, cleansing it of both physical and emotional barriers and promoting profound relaxation and tranquility. 

What Reiki is not: Your practitioner is not a licensed physician, and the state does not require Reiki Practitioners to be licensed. They are intended to complement "state-licensed healing arts services," i.e. traditional Western medicine administered by physicians, nurses, and other licensed medical professionals. 

Theory of Treatment: Illness, trauma, and stress all interfere with the body's normal flow of ki (chi), or "life force energy." Reiki revitalizes the body's capacity to relax and hence helps the body's ability to heal itself by restoring the flow of life force energy through the body. Although one session may suffice, long-term imbalances in the body may necessitate many treatments to allow the body to achieve the amount of relaxation required to restore the system to harmony. To completely benefit from  Reiki therapy, the client's commitment (e.g., desire to make lifestyle adjustments) is frequently required. 

Nature of the Services Provided During a Reiki session: The client is instructed to lie down. During the treatment session,  they will stay completely clothed. The practitioner will spend the majority of the session with their hands around 2-3 inches above the client's body. If guided to do so, the practitioner will ask for your consent before laying hands on your body. But only in a way that is acceptable to you and that is compliant with the legal limits of their practice as a Reiki practitioner. Signs Around Us is currently providing distant healing sessions and therefore does not use a hands-on body approach. Prior to your session, the practitioner will typically utilize a proxy (photo, surrogate, visualization), to establish a connection with your energy field. While it is optional to upload a photo of yourself for your initial appointment, a photo of your pet is required. The practitioner starts the session by allowing the life force energy to flow through their hands. The client may feel heat, cold, vibrating, tingling, mild pressure, or nothing at all, or a combination of these sensations. Other hands-off procedures that the practitioner may employ include sweeping the body of surplus energy in order to dissolve energy blocks. The practitioner acts as a conduit or channel for the life force energy. It is thought that the energy is directed by God/Source/Spirit for the client's physical, mental, emotional, and/or spiritual well-being. As a result, the Reiki practitioner cannot guarantee a certain outcome. 

Animal Reiki: During the session, the practitioner channels healing energy to your pet, focusing on previously discussed areas of concern. This process involves creating a calm and intentional space, employing visualization and meditation techniques to effectively direct the Reiki energy. During the session, owners should ensure a tranquil, distraction-free environment with fresh water, allowing pets to lie in their most comfortable area. Throughout the session, you may notice subtle changes in your pet's behavior, such as increased relaxation or sounds of tummy rumbles, indicating their response to the healing energy.

Qualifications: Our Signs Around Us practitioner holds the title of Reiki Master in Traditional Usui Reiki Ryoho, having successfully completed a comprehensive Master/Teacher Program in 2021. Furthermore, they have obtained certifications in Crystal Reiki, Animal Reiki, and Color Therapy. By combining their diverse qualifications and ongoing exploration of spirituality, esotericism, and energy work, they have seamlessly integrated a range of therapeutic systems and techniques into their practice, allowing them to establish their own distinct style.

Acknowledgment and Consent for Receiving Services: We kindly request your signature prior to your first visit, which will be retained by Signs Around Us for a period of three (3) years. Your signature certifies your acceptance of the information provided to you in compliance with California state law before utilizing our services.

•I have read and understand the above guidelines and disclosure about the treatments and techniques offered by Signs Around Us, as well as their training and education.  
•I have discussed any concerns I have about the nature of the treatment that they will be providing. 
•If I experience any discomfort during the session(s), I agree to immediately inform Signs Around Us.

•I understand that the Reiki practitioner is not a licensed physician and that the alternative services that they will be providing to me are not licensed by the State of California. 
•I understand that Reiki treatments for anybody under the age of 18 are prohibited. 
•I understand that it is my responsibility to maintain a relationship for myself with a medical doctor. 
•I understand that Reiki is a type of energy healing modality and not a substitute for medical treatment or medications. I am aware that Signs Around Us does not diagnose illness or disease nor do they 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 am aware that the confidentiality of any communications pertaining to the client's session performed over the phone, email, virtual meeting platforms, or through any other electronic platform cannot be guaranteed. 
• I understand that unless otherwise required by law, no information about the client will be disclosed to any third party without the written consent of the client.
•I have consented to use the services offered by Signs Around Us, and I agree to be personally responsible for their fees in connection with the services provided. I understand that by providing this informed consent, I hold harmless both the Reiki practitioner with Signs Around Us and the location where the services are provided. 
•If requested, I have been provided with a copy of California Senate Bill SB-577.
 
Animal Reiki:

1. Reiki for your animal is intended to provide relaxation, reduce stress, and promote overall health and well-being.

2. I understand that Reiki practitioners do not diagnose conditions, prescribe veterinary medication, perform medical treatment of any kind, or interfere with the treatment of a licensed veterinarian or other medical professionals.

3. I understand that Reiki is not a substitute for veterinary care or medicine.

4. The session is entirely voluntary, and I may choose to end the session for my animal at any time.

5. The safety and care of my animal are ultimately my responsibility.

6. Reiki can complement any veterinary care that my animal may be receiving, and I agree to inform my practitioner of any significant health changes prior to future appointments.

7. I understand that the body has the ability to heal itself, and complete relaxation is often beneficial for this process.

8. Long-term imbalances may sometimes require multiple sessions to facilitate the level of relaxation needed by the body to heal itself.

9. Reiki practitioners are providing Reiki at my request and are not responsible for the outcome of the session. The animal directs the treatment, therefore session length and results vary for each session.

10. This document, along with a photo of my pet, will be retained for three years and is required only prior to the initial session.

11. By signing, I hereby authorize Signs Around Us to offer Reiki session(s) to my animal.

Client Acknowledgement: I have read and understand the above disclosure regarding the Reiki treatment(s) that I or my animal will receive from Signs Around Us, and I consent to the treatment.

By signing this release, I hereby waive and release Signs Around Us from any and all liability past, present, and future relating to their services, whether they be onsite at the home of the client signing this consent, online, or at another location. Except in cases of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Signs Around Us from any claims or liabilities of whatsoever kind arising out of or in connection with my session(s) or those of my animal.

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Please click the following link to electronically sign the Acknowledgment and Consent form. Additionally, you have the option to upload a photo of yourself or your pet on this form. While it is optional to upload a photo of yourself for your initial appointment, a photo of your pet is required. If you haven't submitted a photo initially, but later decide to do so or wish to change your current photo, you can always email it to us prior to your appointment. The photo you provide will be used for all your sessions and kept on file for three years.  CLICK HERE TO SIGN    

 

Once the form is signed, you can close the signature window or use the back arrow and proceed to schedule your appointment.