Reiki Intake Form Template for Canada

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Key Requirements PROMPT example:

Reiki Intake Form

"I need a Reiki Intake Form for my private practice in Vancouver, focusing on distance healing sessions and including specific sections for recording client energy assessments and chakra readings."

Document background

The Reiki Intake Form is a foundational document used in Canadian complementary therapy practice to establish the practitioner-client relationship and ensure safe, informed treatment delivery. It is designed to comply with provincial healthcare regulations and federal privacy laws while gathering essential information about the client's health status and treatment expectations. This document should be completed before the first Reiki session and updated periodically or when significant changes occur in the client's health status. It includes sections for personal information, health history, informed consent, and privacy policy acknowledgment, serving as both a legal record and a practical tool for treatment planning. The form is particularly important in the Canadian context where complementary therapies must maintain professional standards while clearly distinguishing themselves from regulated healthcare services.

Suggested Sections

1. Client Information: Basic personal information including name, contact details, emergency contact, and date of birth

2. Health History: Current health conditions, medications, surgeries, and relevant medical history

3. Current Symptoms: Present physical, emotional, or mental concerns the client wishes to address

4. Reiki Session Information: Explanation of what Reiki is, what to expect during treatment, and possible effects

5. Informed Consent: Client acknowledgment and consent to receive Reiki treatment, including understanding that Reiki is not a substitute for medical treatment

6. Privacy Statement: Information about how personal data will be collected, used, stored, and protected

7. Liability Waiver: Legal disclaimer and limitation of practitioner liability

8. Client Signature: Space for client signature, date, and practitioner signature

Optional Sections

1. Pregnancy Information: Additional section for pregnant clients, including due date, pregnancy-related conditions, and healthcare provider information

2. Cancer Care Information: Specific section for clients undergoing cancer treatment, including treatment details and oncologist contact information

3. Minor Consent: Additional section when the client is under 18, requiring parent/guardian information and consent

4. Remote Session Protocol: Section for distance Reiki sessions, including specific consent and procedures

5. Payment Policy: Details about fees, cancellation policy, and payment methods

Suggested Schedules

1. Schedule A: Treatment Record: Ongoing documentation of Reiki sessions, including dates, observations, and client feedback

2. Schedule B: Symptom Tracking: Optional form for clients to track changes in their condition between sessions

3. Appendix 1: Reiki Information Sheet: Detailed information about Reiki, its benefits, and what to expect during and after treatment

4. Appendix 2: Self-Care Guidelines: Recommendations for client self-care between Reiki sessions

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Alternative Medicine

Wellness & Spa

Holistic Health

Complementary Therapy

Personal Services

Medical Tourism

Integrative Medicine

Relevant Teams

Legal

Compliance

Client Services

Wellness Services

Administrative Support

Risk Management

Quality Assurance

Customer Relations

Health Documentation

Professional Standards

Relevant Roles

Reiki Master

Reiki Practitioner

Holistic Health Practitioner

Wellness Coordinator

Complementary Therapy Practitioner

Spa Manager

Clinic Director

Wellness Center Owner

Alternative Health Professional

Integrative Health Coordinator

Healthcare Documentation Specialist

Compliance Officer

Risk Management Specialist

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