TRINITY LANE ELECTRONIC INFORMED CONSENT FOR ANIMALS

Practitioner(s): Christina N. Lane, RN, RMT, Amy Hatch, Kellie Surdis

This is a legally binding agreement between the above-named practitioner(s) and I, the client, named below. 

I, the client, understand Reiki is a simple, gentle, hands-on energy technique used for stress reduction and relaxation. I, the client, understand that Reiki practitioners do not diagnose conditions, prescribe, or perform medical treatment, prescribe substances, or interfere with the treatment of a licensed medical professional. I, the client, understand Reiki does not take the place of medical care. It is recommended that I, the client, bring my animal to see a licensed veterinarian or healthcare professional for any physical or psychological ailments my animal may have. I, the client, understand Reiki can complement any medical or psychological care my animal receives. I, the client, also understand that the body can heal itself, and for this, complete relaxation is often beneficial. I, the client, acknowledge that long-term imbalances in my animal’s body sometimes require multiple sessions to facilitate the level of relaxation needed by the body to heal itself. I, the client, acknowledge receipt of Privacy Notice below.

Privacy Notice:

No information about any animal or client will be discussed or shared with any third party without the written consent of the caregiver unless required to by law.

Client Name:_____________________ Client Signature:____________________ Date:_______

Practitioner Name:_________________ Practitioner Signature:_________________ Date:_____