The Reiki Ritual Intake Form

Are you comfortable with gentle hands-on touch at the 7 primary chakra points (head to feet)?

Have you had any of the following (within 30–60 days): Botox or filler, facial surgery, dental work, cold sore, facial tattoos, been pregnant or given birth?

Reiki Ritual Client Acknowledgment & Consent

Reiki is a gentle energy-based practice intended to support relaxation, stress reduction, and overall well-being. It is not a substitute for medical diagnosis, treatment, or care.

I understand that Reiki practitioners do not diagnose medical conditions, prescribe medications, or interfere with treatment from licensed medical professionals. Reiki is not designed to cure disease.

If I have a medical condition, am under the care of a physician, or have concerns about my health, I agree to seek guidance from a qualified healthcare provider. I understand that it is my responsibility

to consult a physician for any medical condition or concern.

I acknowledge that this is a safe, confidential, and judgment-free space.

By signing below, I voluntarily consent to receive Reiki services and release The Ritual Esthetics Room and practitioner from liability related to this session.