Quantum Reiki Package Agreement Form

Name *

First

Middle

Last

Email *

Contact Number *

In the event of a schedule change or emergency, client will be contacted directly by phone.

I have had Reiki before *

My 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. It is completely optional to include your time of birth and location for the purpose of Human Design

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. *

Agree
My Quantum Reiki is for a location therefore this does not apply to me

I 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. *

Agree
My Quantum Reiki is for a location therefore this does not apply to me

I have not consumed recreational drugs or alcohol prior to my session. *

Agree
My Quantum Reiki is for a location therefore this does not apply to me

I 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. *

Agree

Additional information

NOTE: 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.

Soul Healing Essentials

5.0

Based on 5 reviews

Barb Bartee

2020-04-17T02:10:51+0000

Ali Lastuvka is wonderful to work with, each time we do a reiki session or a meditation I am energized and refreshed... and ready to take on more. she has helping me relive anxiety as well as dive deeper into my inner being. She is professional caring, kind and patient...but more than anything she is a passionate healer that cares deeply about the spiritual experience overall. I cant say enough good things about Ali and the Soul Healing Essentials experience.read more

Brie Mattioli

2019-08-01T20:52:00+0000

Ali is a miracle worker 💕 Meeting her has been such an incredible experience, both personally and professionally.... Quantum healing and reiki sessions with her provide instant relief and the safest place to become more attuned to the universe and what your soul is truly seeking. Through Ali I've discovered inner strength, beauty, clarity, and peace. Every time I leave her sessions, I leave feeling radiant and empowered! Ali is also a master at essential oil knowledge and channels the most beautiful meditations. I cannot recommend this incredible holistic healing practitioner enough 💗 Thank you Ali!read more

Alice Lastuvka

2019-08-01T02:39:37+0000

One session about something that bothered me forever and Ali helped me to relive the experience with kind of sad but... very peaceful lasting result, thank youread more

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