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