Quantum Reiki Package Agreement FormPlease enable JavaScript in your browser to complete this form.Name *FirstMiddleLastEmail *Contact Number *In the event of a schedule change or emergency, client will be contacted directly by phone. I have had Reiki before *YesNoMy main reasons for wanting Reiki or energy work are... *NOTE: Provide general comments at the very least but any information will be useful in preparing for the session appropriately.Date of Birth *Your date of birth is required to confirm you are of legal age.I am of legal age and voluntarily wish to participate in a Quantum Reiki session with Ali and understand that Ali is not a doctor, nor does she hold a degree in Psychiatry or Medicine. She can neither diagnose nor treat any type of physical or mental disorder nor is Reiki or energy work a substitutes for regular medical care. *AgreeMy Quantum Reiki is for a location therefore this does not apply to meI understand that I am not a patient, but a co-creator in my Quantum Reiki experience. I understand that any subsequent self-healing involves self care physically, mentally, emotionally and spiritually which may take time. *AgreeMy Quantum Reiki is for a location therefore this does not apply to meI have not consumed recreational drugs or alcohol prior to my session. *AgreeMy Quantum Reiki is for a location therefore this does not apply to meI understand that all information I give for the purpose of the session will be held as strictly confidential and that any misleading information I provide or information that is purposely omitted may skew the session. *AgreeAdditional informationNOTE: Provide any additional information you may feel is relevant to the booking of this session including any/all prescription medications used for anxiety, depression, seizures or pain. Please advise if you have ever been treated for schizophrenia, MPD, psychosis or PTSD. Submit