Client/Waiver Form Complete Your Contact Info: Please enable JavaScript in your browser to complete this form.Name *FirstLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail *Gender *MaleFemaleOtherComment or Message *Medical Information and Health IssuesEmergency Contact *List Health Conditions if Any *List of Prescriptions You Are Taking *Name of Your Primary Physician *How did you hear about us? *InternetFriend/FamilyHealthcare ProfessionalOtherSelect Session You Are Seeking: *Reiki Cranial SacralCombinedLocation of Service- Home visits not available *Blue Island, IL Tinley Park, ILRemote via phone or internetTerms and AgreementsREAD AND CHECK THE CHECKBOX TO STATE YOU HAVE READ, UNDERSTAND AND ACCEPT THE TERMS. I understand that Reiki/Cranial Sacral Therapy is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki/Cranial Sacral practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Reiki/Cranial Sacral Therapy does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. I understand that Reiki/Cranial Sacral Therapy can complement any medical or psychological care I may be receiving. 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 in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. *I AcceptPAYMENT, CANCELLATION, AND REFUND POLICY Payment in full required prior to reiki/Cranial Sacral session Client/waiver form must be completed fully and submitted prior to a session Notice of cancellation made at least 24 hours in advance of scheduled session will generate a refund Same day cancellation will not be refunded PRIVACY POLICY: No information about any client will be discussed or shared with any third party.WebsiteSubmit Share this:FacebookEmailPrintLike this:Like Loading...