SB-577 Reiki

In accordance with California Senate Bill SB-577

California Client Information Form & Waiver

Version Jan. 1, 2003

Welcome to Reiki!

The purpose of this form is to give you some basic information on Reiki.

What is Reiki?
Reiki is a form of complementary health care practices, which has been found to enhance the body’s ability to heal itself.

What Reiki is not
Your practitioner is not a licensed physician, and Reiki does not require licensing by the state. It is meant to be a complement to “healing arts services licensed by the state”; i.e., it is a complement to traditional Western medicine provided by doctors, nurses, and other licensed medical professionals.

Theory of Treatment
Stress, trauma and illness restrict the natural flow of ki (chi) or “life force energy” through the body. By restoring the flow of life force energy through the body, Reiki rejuvenates the body’s ability to relax and, therefore, supports the body’s ability to heal itself. Although one session may be adequate, long-term imbalances in the body sometimes require multiple treatments in order to allow the body to reach the level of relaxation necessary to bring the system back into balance. Improvement often requires commitment on the client’s part (e.g., willingness to make lifestyle changes) in order to fully benefit from Reiki treatment(s).

Nature of the Services Provided
During a Reiki session, the client is asked to lie down or a chair can be used as well for ease. He/She remains fully clothed during the treatment session. The majority of the session will involve the practitioner holding his/her hands about 2-3 inches above the client’s body. If guided to do so, the practitioner will ask permission to place his/her hands on your body but only in a manner acceptable to you and within the legal limits of his/her practice as a Reiki Practitioner.
Once the session begins, the practitioner allows the life force energy to flow through his/her hands, which may be experienced by the client as heat, coolness, vibrating, tingling, a light pressure, a slight pulling sensation, or nothing at all. The Practitioner may also use other hands-off techniques, such as sweeping the body of unneeded energy or using vocal tones to break up energy blocks. The practitioner is simply a conduit or channel of the life force energy. It is believed that the energy is guided by God/Source/Spirit for the physical, mental, emotional, and/or spiritual well-being of the client. Therefore, a specific outcome cannot be guaranteed by the Reiki Practitioner.

Marcela O’Bryon’s Qualifications
I am a Reiki Level I & II practitioner certified in 2019 by my teachers Mija Cameto and Shar Joy at The Journey Center in Shingle Springs, CA. I have been practicing reiki since then. I intend on graduating as a Reiki Master in 2020 with my aforementioned teachers. I am also an Ordained Minister from the Universal Life Church Monastery.

Acknowledge & Consent to Receive Services
In order to use Marcela’s services, California state law requires that you acknowledge receipt of the information provided in this form and that you sign it. You will be provided with a copy for signature at your first visit. I, Marcela, will keep the original in her records for three (3) years.
 I have read and understand the above guidelines and disclosure about the treatments and techniques offered by Marcela O’Bryon, as well as her training and education.
 I have discussed with Marcela any concerns I have about the nature of the treatment that she will be providing.
 If I experience any discomfort during the session(s), I agree to immediately inform Marcela.
 I understand that Marcela is not a licensed physician and that the alternative services that she will be providing to me are not licensed by the State of California.
 I understand that it is my responsibility to maintain a relationship for myself and/or my child with a medical doctor.
 I understand that Reiki is not a substitute for medical treatment or medications. I am aware that Marcela does not diagnose illness or disease nor does she prescribe medications or recommend supplements. 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.
 I have consented to use the services offered by Marcela, and I agree to be personally responsible for her fees in connection with the services provided.
 If requested, I have been provided with a copy of California Senate Bill SB-577.

Client Acknowledgment
I have read and understand the above disclosure regarding the Reiki treatment(s) I will be receiving from Marcela O’Bryon. I have been provided a copy of the above document, in accordance with California State Law SB-577:

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Print Name of Client

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Print Name of Person Signing (if different)

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Relationship to Client

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Signature

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Date