Reiki Health Waiver | Wild Woman | Yoga

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Reiki Health Waiver

To register for a reiki session please fill out the following medical form

First Name

Email Address

Last Name

Date of Birth

Current Medications and dosage

Are you currently under the care of a physician? *

No

Yes

Have you ever had a reiki session before? *

No

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete.

Thanks for submitting!

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