Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Equipment *

Will you be bringing your own yoga mat and blocks?

Yes, I will bring my own

No, I will need to borrow the clinic's

REIKI TERMS & CONDITIONS *

Reiki treatments are given fully-clothed on a massage table and should not be mistaken for a massage. Reiki is a simple, hands-on energy technique that is used only for stress reduction and relaxation and is not a substitute for medical treatment. Reiki can complement any medical or psychological care you are receiving It is recommended that you see a licensed physician or licensed health care professional for any physical or psychological ailment you may have. As a Reiki practitioner, I do not diagnose conditions nor do I prescribe or perform medical treatments, prescribe substances, nor do I interfere with the treatment of medical professionals. Long-term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself and bring your systems back into balance. Self-improvement requires commitment on your part, and you must be willing to change in a positive way if you are to receive the full benefits of Reiki. All information received during your Reiki session will be held in the strictest of confidence unless there is a threat of danger where you might harm me or yourself as required by a court of law. You agree to turn off all your electronic devices before arriving to create a peaceful and relaxing environment for everybody in the sanctuary. You will arrive 10 minutes before your appointment and you understand that the center has a tight schedule. If you're less than 15 minutes late, you'll receive a shorter session as I may not be able to lengthen the session. If you're more than 15 minutes late, your appointment will be rescheduled. The full service fee will be charged. Do you understand and Agree?

I agree

I do not agree

REFUND & CANCELATION POLICY *

There are no refunds on Reiki services that have already been provided. If you need to cancel or reschedule an appointment, please give 24 hours notice. If you do not show for your appointment, and have paid in full, a refund will not be issued. If you do not show for your appointment, and have not paid in full, you will be charged the full service fee. Do you understand and agree?

I agree

I do not agree

REIKI LIABILITY DISCLAIMER

I hereby release Maria Petropoulos and Light and Balance Reiki and Yoga from all liability arising out of any reliance upon the advice / information given during the consultation of my Reiki session given at this time or any time in the future. I assume all risks and responsibilities for myself and release Maria Petropoulos and Light and Balance Reiki and Yoga from any injury or liability that may occur during a treatment session. I have read, understand and agree to these policies, terms and conditions.

I agree

I do not agree