Energy Work Informed Consent / Release Statement
Name: ________________________ Date: ______________________
Before your session, please read and initial each of the following indicating your understanding:
______ What is Reiki?
- The Usui System of Reiki Healing is a palms-on and/or palms-hovering, energetic healing practice. Reiki is a healing technique that uses the Universal life force energy to balance the subtle energies within our bodies and to encourage healing. Reiki practitioners act as a conduit or channel through which Reiki energy travels. The intended result of receiving Reiki is a balanced physical, mental, emotional, and spiritual being. Most people experience a sense of relaxation and euphoria, but like any form of healing it is not uncommon for people to experience emotional or physical detoxification.
Healing Touch is a light, gentle, energetic touch on or near the body. Gentle touch assists in balancing the physical, emotional, mental and spiritual well-being, supporting the natural ability to self-heal.
______ What happens during a Reiki treatment?
During a Reiki treatment, you will lay fully clothed on a massage table, comfortably on the floor, or sit comfortably in a chair, listening to soothing music. Your Reiki practitioner will lay their hands on or above your body in a series of hand positions to deliver Reiki energy. A Reiki treatment generally covers your head, the space above the head, the front of your body and your feet. Reiki can be preformed by hands on, or hands off / hovering above the body. Sessions are usually done without talking and it is helpful to have calming music to aid relaxation and deepen healing.
______ What happens during a Distance Reiki treatment?
Before your distance treatment session time begins, your reiki practitioner will cleanse the space and set an intention to healing for the highest good of the recipient. You may choose to receive your treatment while at home or any otherwise safe space. A calm, relaxed, meditative or even sleeping state is preferred to receive the work. The distance reiki session will then proceed like a regular reiki session. Although it is possible to do a phone or video call before or after your session, it is not necessary to follow up on any sensations you would like to share with your reiki practitioner.
______ What does Reiki feel like?
Reiki tends to feel warm and profoundly relaxing. You may feel the hands of the Reiki practitioner become hot or tingly. Some people describe a floating sensation and some see colors or shapes during the session. Some people fall asleep. Some experience emotional release. There is no expected experience- Reiki treatment is unique for each individual who receives it.
Some common results of Reiki treatment include:
- Perceived reduction in stress
- Increased relaxation
- Enhanced sense of balance, centeredness and calm
Just like meditation, or movement arts, the effects of Reiki are cumulative. While one session can work wonders, repeated, regular Reiki treatments can invite significant improvement. As an example: if you exercise for an hour, you will receive benefit. If you exercise every day for a month, the results will be much more profound. Reiki works similarly – regular sessions support well-being in every way.
_______ Reiki is not a replacement for traditional medical treatment.
I understand that Reiki is a relaxation and stress reduction technique. I acknowledge that treatments administered are only for the purpose of helping me relax and to relieve stress. Reiki practitioners do not diagnose conditions, nor do they prescribe substances or perform medical treatment, nor interfere with the treatment of a licensed medical professional and are not licensed by the state of Illinois.
I further understand that Reiki treatment received from Erin Howe through SDDMT is not to be construed as a substitute for medical examination, diagnosis or treatment. It is recommended that I see a licensed health care professional for any physical or psychological ailment I may have. Reiki is a complementary medical art that works well alone as well as in concert with other treatments. While I understand it’s benefits I acknowledge it is not a cure for any medical or psychological conditions.
______ Reiki care does not relate to or fall under Erin’s therapist certification, BC-DMT.
Erin Howe is performing this service as a Reiki Master, I understand that Erin Howe of SDDMT is a Board-Certified Dance/Movement Therapist (BC-DMT) and that Reiki sessions are not in relation to other licenses and certifications. I understand that a Reiki assessment should not be valued as therapy. Furthermore, I understand that if I have any physical or medical complaints I am to notify Erin Howe prior to beginning a session, so that any Reiki work may be done under full disclosure of health. I also understand should I desire her to treat any other complaints under her therapy license I am to schedule accordingly.
I also understand that Reiki is an energetic healing methodology, which involves the laying on of hands. I understand that I will be fully clothed during the session, and experience a series of hand positions on and/or above my body. Having read, completed and understood the foregoing, I request to receive Reiki treatment. I understand that my practitioner is providing Reiki treatment for me at my request, and is not responsible for the outcome of the Reiki session. I agree to hold Erin Howe of SDDMT harmless for any intended or unintended result. This disclaimer and consent form will be kept on file for one year from the initial signing and will cover any and all Reiki sessions held in this time period.
$40 (30 minute) / $75 (50 minute) at time of service.
Providing a tip is acceptable but not expected and is entirely optional.
Reiki is not covered by insurance.
Provide 24 hour cancellation notice, otherwise $25 cancellation fee is applied.