EmailMe Form - Animal Reiki Consent & Waiver Form

Client & Animal Information

Owner/Guardian Name *

First Last

Telephone *

### - ### - ####

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Animal’s Name *

Species/Breed *

Age *

Sex *

Male

Female

Health Issues or Behavioral Concerns *

Consent & Understanding

Please read and agree to each section:

I understand that Reiki is a complementary healing modality and does not replace veterinary care. *

I agree

I confirm that I am the legal owner or guardian of the above-named animal, and I give permission for the Reiki practitioner to provide Reiki sessions. *

I agree

I understand that Reiki is a gentle, non-invasive energy practice and that animals will never be restrained or forced to participate. *

I agree

I acknowledge that animals may choose how and whether to receive Reiki (e.g., moving closer, walking away, lying down). *

I agree

I agree to observe and respect my animal’s behavior and signals during and after sessions. *

I agree

I understand that results may vary, and no specific outcomes are guaranteed. *

I agree

I release the practitioner from all liability related to the Reiki session(s) and any changes in the animal’s behavior or condition. *

I agree

Session Preferences *

In-person session

Distant Reiki session

Hands-on (if animal consents)

Hands-off only

Preferred session date/time (if applicable):

Owner/Guardian Print Name *

First Last

Date Signed *

MM / DD / YYYY

By signing below, I confirm that I have read, understood, and agree to the terms of this consent form. *

Clear

Fees

$50.00 (15 – 60 minutes) Guided by the animals interest.
Fee may be paid by cash or e-transfer to michelle@michellehmadden.ca