Please read and fill out this form prior to your Reiki appointment. If you have any questions you can email info@mediumlisamercier.com Thank you!
California Client Information Form, Acknowledgement, & Consent to Receive Treatment
(In accordance with California Senate Bill SB-577)
What is Reiki?
Reiki is a form of complementary health care practice, 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. He/She remains fully clothed during the treatment session. The majority of the session will involve the practitioner holding her hands about 2-3 inches above the client’s body.
Once the session begins, the practitioner allows the life force energy to flow through 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.
Lisa Mercier’s Qualifications
Lisa Mercier is a Reiki Master/Teacher who is a certified Healer. She has been practicing Reiki since 2015. Lisa is also a certified Psychic and Medium. She studied under Dr. Anne Reith at the Impart Wisdom & Wellness Center of California. Lisa also holds a bachelor’s degree in psychology from Indiana Wesleyan University.
Acknowledge & Consent to Receive Services
In order to use Lisa Mercier’s services, California state law requires that you acknowledge receipt of the information provided in this form and that you sign it. Lisa Mercier will keep the this in her records for three (3) years.
I Acknowledge:
- I have read and understand the above guidelines and disclosure about the treatments and techniques offered by Lisa Mercier, as well as her training and education.
- I have discussed with Lisa Mercier 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 Lisa.
- I understand that Lisa Mercier 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 Lisa Mercier 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 Lisa Mercier, and I agree to be personally responsible for her fees in connection with the services provided.
- I will not hold Lisa liable for any new or existing medical conditions or personal injury(ies) that may occur while receiving treatment in her home/office or our agreed upon service location.
- I agree to settle any legal disputes through arbitration administered by the American Arbitration Association in Westminster, California at my complete expense. Judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction thereof.
- If requested, I have been provided with a copy of California Senate Bill SB-577 and/or this signed form.
I have read and understand the above disclosure regarding the Reiki treatment I will be receiving from Lisa Mercier. This consent form will be valid for one year from the signing/submitting date.
