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Reiki Client Information and Consent Form

In order to provide you the best possible wellness care, please complete this form. Your privacy is important to us. This form is HIPAA compliant and we will never share any identifying information with any third parties without your direct consent. Make sure you see "Mahalo for your submission" after you click Submit, otherwise the Doctor will not have received your form!

Carefully read the following Informed Consent Form and digitally sign below.

Dr. Christine Teaño Lipat, DC, Certified Functional Medicing Practitioner, is a White Light Reiki Master since 2004 and Registered Karuna Reiki® Practitioner with the International Center for Reiki Training.

I hereby voluntarily request and consent to receive Reiki services from Dr. Christine Teaño Lipat, DC, CFMP, White Light/Karuna Reiki® Master. I understand and acknowledge that no guarantees have been made to me as to the effect of such services. I further understand and acknowledge that in no way are these services meant to be construed by me as the diagnosis or treatment of disease, but rather as an aid to balancing my energy and to possibly improving my general wellness. I understand that prior to my first Reiki session, I will receive an oral explanation of and description of a Reiki session. I understand that I may refuse any and all services at any time during my first session or during any subsequent sessions. I understand that Dr. Lipat upholds the highest standards of care and professionalism and as an IARP® Registered Reiki Professional Code of Ethics. A copy is available for review here: http://iarp.org/iarp-code-ethics/.

I understand that Reiki services provided by Dr. Lipat are simply intended to enhance relaxation and to aid in stress reduction. I understand that Reiki is not a substitute for medical treatment or medications, and it is recommended that I concurrently work with my Doctor or Primary Caregiver for any condition I may have. I am advised that if I am sick, I should consult my Doctor. I am aware that my Reiki Practitioner does not diagnose illness or disease and does not prescribe medication. If I experience any discomfort during the session, I will immediately communicate that to the practitioner so the treatment can be adjusted. I also understand and believe that the body has the ability to heal itself; and to do so, complete relaxation is often beneficial. Long term imbalances in the body sometimes require multiple treatments to allow the body to reach the level of relaxation necessary to bring the system back into balance. I understand and believe that self-improvement requires commitment on my part, and that I must be willing to change in a positive way if I am to receive the full benefit of a Reiki treatment.

You are done! Thank you for taking the time to fill this out. Make sure you see "Mahalo for your submission" after you click Submit. If you didn't, look to see if you missed a required question! Otherwise, the Doctor will not have received your form!