Reiki Shaman Services-Client Form

Client Information/Treatment Form
Jim PathFinder Ewing

PLEASE USE THE CONTACT FORM, bottom left on the side menu, if you are inquiring about classes!
Otherwise you will be asked for the $75. deposit.

Terms

I understand that Reiki, Shamanic and/or complementary, alternative, vibrational, energy medicine techniques are for stress reduction and relaxation. I acknowledge that treatments administered are only for the purpose of helping me relax and to relieve stress.

Reiki, Shamanic and/or complementary, alternative, vibrational, energy medicine practitioners do not diagnose conditions, nor do they prescribe substances or perform medical treatment, nor interfere with the treatment of a licensed medical professional. It is recommended that I see a licensed physician, or licensed health care professional for any physical or psychological ailment I may have.

I also understand and believe that the body has the ability to heal itself, and to do so complete relaxation is often beneficial. Long-term imbalances in the body sometimes require multiple treatments to allow the body to reach the level of relaxation necessary to bring the system back into balance.

I understand and believe that self-improvement requires commitment on my part, and that I must be willing to change in a positive way if I am to receive the full benefit of a Reiki, Shamanic and/or complementary, alternative, vibrational, energy medicine techniques treatment.

I acknowledge my commitment to my self-improvement process. I recognize that a Reiki, Shamanic and/or complementary, alternative, vibrational, energy medicine techniques treatment program must be followed to be truly effective, just as prescribed medication is only effective if taken as directed.

I understand that information I submit on this secure form is confidential and will not be shared or used in a mailing list.

After you submit the form, please return to our site by clicking the "back" arrow in your browser. The next step is to submit the $75.00 deposit on services. After you submit the form, you will be redirected to the payment page. Thank you.

VERY IMPORTANT! BEFORE YOU FILL OUT THE FORM:

Please add: bisonsmile@bellsouth.net

to your email contact list, or our response may go to your "spam" folder--

especially if you use "Yahoo". Thank you!

By filling out and submitting this secure form, I am in agreement with the above terms and conditions of treatment.


	Agreement and Contact Information By filling out and submitting this secure form, I am agreement with the above terms and conditions of treatment.
	First Name*
	Last Name*
	Home Phone*
	Other Phone
	Email*
	Birth Date*
	What is your gender?*
	Please Briefly List Reason(s) for Requesting Our Service*
	Address* City State/Province Zip/Postal Country

Client Information/Treatment Form Jim PathFinder Ewing

Agreement and Contact Information

Client Information/Treatment Form
Jim PathFinder Ewing