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Welcome, I am so happy you are here!

CLIENT INTAKE FORM

Below you will find your client intake form. Please fill out prior to your session!

Looking forward to hearing from you soon!

Please see New Refund policy as of September 2022!

No cash Refunds. Credits are often given and require a written request. Diana will use her best discretion to determine if a credit can be given and if a expiry is needed. Emergency cancellation of a private session has no fee. Cancellation of a class (due to student issue or having to go online) will be credit only as well. Please reach out with any questions.

CLIENT DETAILS

Date *

Client Name *

First

Last

Date of Birth *

Sex *

Email *

Confirm Email

Would you like to be added to my newsletter?

Yes please

Cell Phone Number

Type of Appointment *

What is your intention? What are you looking to get out of this session? *

EMERGENCY CONTACT INFORMATION

Emergency Contact's Name *

First

Last

Contact Number *

Relation to Client *

FINAL STEPS

Additional Questions or Comments

Waiver of Liability, Consent agreement - Please type full name in box below - By submitting you are agreeing to; *

I the undersigned understand that I am consulting with a natural health educator and or a Reiki therapist. I affirm that I am consulting with the natural health educator and or Reiki therapist out of my own free will and I understand that there will be no diagnosis made, nor prescriptions given. The session is not an exam or treatment appointment of any medical kind. This does not replace the function of any medical professionals, including psychiatrist/psychologist or other mental health care practitioners. I agree that I am to use the educational advice at my own risk. I agree that the Reiki Therapist has my permission to facilitate Reiki treatment and may include light touch.

Refund Policy

No cash Refunds. Credits are often given but must be requested in writing. Credits may have expiry dates. Emergency cancellation for private sessions have no fee. Classroom payments will also be credit only. Please reach out with any further questions or place question above.

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