PLEASE READ THE FOLLOWING CLIENT INFORMATION

Your Reiki Practitioner

Madison Blue, referred to in this contract as The Consciously Curious. She is trained by the International Center for Reiki Training. Madison is a Master level Reiki Practitioner operating in Utah as a spiritual healing art and “educational licensing exemption” under State of Utah Department of Commerce Division of Occupational and Professional Licensing “Position Statement” as of December 11, 2012 Updated September 29, 2015, which allows reiki practitioners to practice legally in Utah without a license as “spiritual healing art” and does not involve the methods outlined in the scope of practice of Massage Therapy.

What is Reiki?

Reiki is a Japanese technique for stress reduction and relaxation that also promotes healing. It is administered by utilizing healing touch and is based on the idea that an unseen "life force energy" flows through us and is what causes us to be alive. Reiki utilizes the theory that light touch of the practitioner’s hands promotes energy balance, improving overall healing of the client. If one's life force energy is low, then one is more likely to experience illness or stress. If it is high, one is more capable of feeling relaxed, happy and healthy. The client can expect to be fully clothed in a lying or sitting position and will experience light touch, if touch is consented to by a client. Reiki is not bound by time or space. If the client cannot be physically present, Reiki can be sent from a distance as long as the client has authorized and accepted the energy healing.

Reiki can help achieve emotional balance, inner peace, and energetic healing. Reiki may help develop a stronger sense of self, intuition, and improved mood balance. Results of Reiki may vary for individuals. Therefore, a specific outcome cannot be guaranteed by the Reiki Practitioner.

What Reiki is Not

Reiki is not massage therapy and does not fall under the Massage Therapy Practice Act. Reiki does not use the examination, assessment, and evaluation of the soft tissue structures of the body for the purpose of devising a treatment plan to promote homeostasis; the systematic manual or mechanical manipulation of the soft tissue of the body.

Reiki is not psychology, psychiatry or medicine and the Reiki practitioner is not a licensed physician, psychologist, or psychiatrist. Reiki is intended to be a complement to traditional Western medicine provided by doctors, nurses, and other licensed medical professionals. If you believe you are ill, please see a licensed medical professional prior to beginning Reiki treatment.

Client certifies that they do not suffer from any physical or mental disability that may affect their participation in the services with the practitioner and if they have a mental or physical illness, they have consulted with their health care provider and have been advised they may participate in the services by the practitioner. Client agrees if there is any change in representation, the practitioner will be promptly advised. Client is responsible for creating and implementing their own physical, mental, and emotional well-being, decisions and results. Therefore, the client agrees that the practitioner is not and will not be liable for any actions or inactions or of any direct or indirect results of the services provided by the practitioner.

The practitioner makes no guarantees or warranties, expressed or implied. In no event will the practitioner be liable to the client for consequential or special damages. I, the client, agrees that in the event of any claim or grievance by me against the practitioner, my sole remedy will be the return of the fees paid. The practitioner is not responsible for any direct, indirect or incidental or consequential damages beyond the total amount of fees paid by the client.

ACKNOWLEDGEMENT & CONSENT TO RECEIVE SERVICES

1. I have read Client Information and understand the above guidelines and disclosure about the treatments and techniques offered by Madison Blue, The Consciously Curious, as well as her training and education.

2. I understand that Madison Blue, The Consciously Curious, is not a licensed physician and that the alternative services I will be receiving are not licensed nor required to be licensed in the State of Utah.

3. I understand that Madison Blue, The Consciously Curious, is not a licensed Massage Therapist and that the alternative services I will be receiving are not licensed nor required to be licensed in the State of Utah, as they are a spiritual healing art.

4. I have discussed any concerns I have with the practitioner about the nature of the treatment I will be receiving.

5. I will immediately inform the practitioner if I experience any discomfort during the session(s).

6. I acknowledge that long-term imbalances in the body may require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.

7. I understand that it is my responsibility to maintain a relationship for myself and/or my child with a medical doctor.

8. I understand that Reiki is not a substitute for medical treatment or medications. I am aware that Madison Blue, The Consciously Curious, does not diagnose illness or disease nor does she prescribe medications. I understand that any suggestions that are provided to me should not be taken as a diagnosis or recommendation against the advice of a licensed physician or mental health professional.

9. I have consented to use the services offered by Madison Blue, The Consciously Curious, and I agree to be personally responsible for her fees in connection with the services provided.

10. I understand Reiki healing consists of light on the body touch. By signing below, I agree to touch by the practitioner.

11. I understand that Reiki can be sent at a distance and work just as effectively as in person. By singing below, I agree to have Reiki sent to me at a distance.

12. I understand that results of Reiki may vary for individuals. Therefore, a specific outcome or results cannot be guaranteed by Madison Blue, The Consciously Curious.

13. I understand if I cancel or reschedule my appointment with less than 24 hours notice, I will be charged 100% of the appointment/class/workshop fee.

14. I understand Madison Blue, The Consciously Curious, does not offer refunds.

15. Privacy Notice: No information about any client will be discussed or shared with any third party without written consent from the client or parent/guardian if the client is under 18.