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Spiritual Mentoring & Energy Healing Certification
Consent & Liability Form

Please fill out the following form in order to participate in Reiki & Energy Healing Session(s).

Are you currently under the care of a physician?
Have you ever had a reiki & or energy healing session before?

I understand that:

  • Life Coaching & Spiritual Mentoring is present & future focused & does not replace care I may be receiving from a licensed health professional. 

  • It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have or may experience later on. If experiencing thoughts of self harm, emotional and or mental distress, and or personal emergency, I must call 911 or local emergency services immediately.

  • I understand that certified life coaches, reiki practitioners, & spiritual life coaches do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. 

  • These sessions are not meant to replace treatment by established medical practices & professionals, but to complement them. These sessions can also create a more synergetic result with other interventions, treatments & modalities.

  • No guarantees as to the results of treatment, mentoring & or education are expressed or implied by the practitioner.

  • It is advised to drink plenty of water prior & after my reiki & energy healing classes & or session(s). By failing to increase my water intake, I am increasing my chances of experiencing potential side effects.

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Potential side effects of reiki & energy healing include but are not limited to the following:

Dizziness , Headaches, Vertigo, Nausea, Fatigue, Heightened Emotionality, Tingling Body Sensations & Changes in Digestion. 

 

Jordyn Kurtz is a Certified Reiki Master, Quantum & Shamanic Healer, Spiritual & Shamanic Life Coach, Certified Breathework Coach and is not a licensed physician and will neither diagnose nor prescribe any condition that I might have nor does she make any specific claims regarding results from the Mentoring, Life Coaching, Reiki & Energy Healing Classes & or sessions that I receive.

I agree to:

  • Raise any questions or concerns about anything I do not understand prior to our session(s).

  • Fulfill all payments in full & on time. 

  • Increase my water intake prior to & after any energy healing work I may participate in during our session(s)

  • Consider any suggestions that the practitioner may raise concerning referrals to other health care practitioners, homework, or my desired focus/introspection.

  • Take full responsibility for my own health care, actions & effort.

  • Give consent to Jordyn Kurtz to conduct Life Coaching & or Mentoring session(s). I give consent to Reiki &  Energy Healing Sessions & I acknowledge that these sessions & energy work included in my coaching & mentoring may include physical touch & I am fully aware of the risks and provide consent to Lead By Light, Jordyn, to conduct these session(s)

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Release of Liability Clause:

Except in the case of gross negligence or malpractice I, or my representative(s) agree to fully release and hold harmless, Jordyn Kurtz, Lead By Light, LLC,, from and against any and all claims or liability of whatsoever kind of nature arising out of or in connection with my classes & or session(s). My questions have been answered to my satisfaction regarding my Life Coach's, Mentor's & Energy Healing Practitioner's background, credentials, and what I might expect from this session. I understand that all information related to my sessions will be kept in confidence unless specified in writing, or governed by law.

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Thanks for submitting!

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