Animal-Reiki-Waiver-Form

Animal Reiki Client Waver

All asterisk * marked fields are required

Enter your full name and date below to acknowledge agreement with this statement:

"I, [FULL NAME ENTERED BELOW], understand that the Reiki session(s) commencing on [DATE ENTERED BELOW] for my animal(s) [ANIMAL NAME(S) ENTERED BELOW], is intended to provide relaxation, reduce stress, promote overall health and well-being. 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."

Full Name*

Today's Date*

Animal Name(s)*

Separate multiple names with comma

Animal Type(s)*

Separate multiple types with comma

Check the box next to each statement to confirm you accept ALL of the statements.*

Check box to confirm agreement

1) I understand that Reiki is not a substitute for veterinary care or medicine and that I may need to receive permission from my veterinarian in order to request Reiki sessions.

Check box to confirm agreement

2) I understand that the session is totally voluntary, and I may choose to end the session for my animal at any time.

Check box to confirm agreement

3) I understand that the safety and care of my animal is ultimately my responsibility.

Check box to confirm agreement

4) I understand that Reiki can complement any veterinarian care that the pet may be receiving. I agree that I will inform my practitioner of any significant health changes prior to future appointments. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long-term imbalances may sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. I understand that 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 per each session.

Check box to confirm agreement

5) I authorize Theresa Luzzi to offer Reiki session to my animal.

Digital Signature*

Enter your full name again to act as digital signature to authorize the session.

Email Address*

Re-enter email address to confirm*