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Reiki & Energy Healing
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:

  • Reiki is a Japanese form of relaxation & is a simple, gentle, energy technique that is used for alleviating stress, reducing pain perception & assisting the body in returning to optimal state of wellbeing. 

  • I understand that Reiki 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. 

  • It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. 

  • It is advised to drink plenty of water prior & after my reiki & energy healing 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. 

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  • 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. 

  • Any suggestion made by the practitioner, Jordyn, Lead By Light, LLC,  will be to assist my body's natural healing ability to achieve a balanced energetic state, to the extent that my body & or my highest knowing will allow.

  • The goal of my session will be identified prior to beginning the reiki & or energy healing session. I will have input into my goals, as well as give intent for it prior to beginning the session.

  • 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 are expressed or implied by the practitioner.

 

Jordyn Kurtz is a Certified Reiki Master, Quantum & Shamanic Healer 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 Reiki & Energy Healing sessions that I receive.

I agree to:

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

  • Pay all session fees in full prior to session(s).

  • Increase my water intake prior to & after my 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.

  • Give consent to Jordyn Kurtz & Lead By Light, LLC to conduct an energy healing & or reiki healing session. I acknowledge that this includes physical touch & I am fully aware of the risks and provide consent to Lead By Light, Jordyn, to conduct reiki & energy healing session(s).

 

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, from and against any and all claims or liability of any nature arising out of or in connection with my session(s). My questions have been answered to my satisfaction regarding my Energy Healing Practitioner's background & credentials and what I might expect from this session and potential side effects. I understand that all issues related to my sessions will be kept in confidence unless specified in writing, or governed by law.

Thanks for submitting!

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