Please fill out Consent Form Below

I understand that Nanci Miranda is providing Reiki at my request. I hereby waive and release Nanci Miranda from any and all liability past, present, and future relating to her services.

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I also understand that Reiki is an Energy Healing methodology that may include the laying on of hands to a person who remains fully clothed. There will be no touching of the breasts, genitals or buttocks.

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I understand that I may stop treatment at any time, either during or outside of each session, and that I am responsible for voicing any concerns regarding treatment as they present themselves, so that the practitioner, Nanci Miranda, may address them in a timely and conscientious manner.

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Confidentiality: Whatever we discuss is strictly confidential. The only circumstances in which I would find myself needing to share information outside of our sessions with another professional or with authorities would be if I deemed you to be of any possible harm to yourself or another individual. If you wish for me to make contact or do research for you or leave messages with others I will need a release giving me permission to do so.