Client Intake and Waiver Form – Animal Reiki Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Date of SubmissionName *FirstLastAddress *Email *Phone No. *Animal's Name *Type of Animal (i.e. cat, dog, horse, parrot, etc.) *Animal's gender *MaleFemaleAnimal's age *Veterinarian's NameVeterinarian's Phone No. needed and veterinary Why are you wanting your animal to receive Reiki sessions? *What medications and treatment is your animal currently receiving? *Can you describe what a typical day looks like for your animal? Please include the times the animal sleeps, activity (including types and duration), contact with other animals, food types and amounts as well as your time spent with the animal. Including locations (ex: kennel, field etc.) is also helpfulAdditional Comment or MessageI understand that the Reiki session(s) for my animal, is intended to provide relaxation, reduce stress, promote overall health and well-being. I understand that Reiki practitioners do not diagnose conditions, prescribe veterinary medication, perform medical treatment of any kind or interfere with the treatment of a licensed veterinarian or other medical professionals. I understand that Reiki is not a substitute for veterinary care or medicine and that I may need to receive permission from my veterinarian in order to request Reiki sessions. I understand that the session is totally voluntary, and I may choose to end the session for my animal at any time. I understand that the safety and care of my animal is ultimately my responsibility. I understand that Reiki can complement any veterinarian care that the pet may be receiving. I agree that I will inform my practitioner of any significant health changes prior to future appointments. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long- term imbalances may sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. I understand that Reiki practitioners are providing Reiki at my request and are not responsible for the outcome of the session. The animal directs the treatment therefore session length and results vary per each session. I authorize PAOLO GEMMA to offer Reiki session to my animal. *I do understand and authorizeSubmit
