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Please read the following explanation of Reiki and sign the form before the session:

Reiki is a Japanese word that means universal energy. Reiki is increasingly recognized in the West as a beneficial adjunct to allopathic medicine.

Used in hospitals before, during and after surgery, Reiki is believed to enhance the body’s ability to heal itself. Additionally, Reiki and other forms of energy work have much to offer in the way of increasing wellbeing and resilience. It is stress reducing, balancing and relaxing.

Like meditation, Reiki treatments have a cumulative benefit. They are supportive of well-being in every way. While Reiki supports wellness for the physical, emotional and mental body, it is not a “magic cure” and is no replacement for licensed medical treatment.

Reiki is delivered while the client is either seated in a chair or lying supine. It is not a form of massage and the client remains fully clothed.

I understand that Reiki is a relaxation and stress reduction technique. Reiki practitioners do not diagnose or prescribe substances, nor interfere with treatment of a licensed medical professional. Reiki practitioners are not currently licensed in the US. I understand that Shawn Marie Cichowski is not a licensed physician, and that Reiki is complementary to and separate from medical services licensed by the state.

I also understand that Reiki is an energy healing methodology that includes the laying on of hands to a person who remains fully clothed. There will be no touch of breasts, genitals or buttocks.

I understand that Reiki is being provided by Shawn Marie Cichowski. I agree to hold Shawn Marie Cichowski harmless and understand that she is not responsible for the outcome of the session.

WNY Life Coaching Center Informed Consent and Legal Disclaimer

I hereby acknowledge and affirm understanding and agreement with the above. I understand that by entering my name, the date and my electronic signature on this form that this constitutes a legal signature.

  • Name*

First Last

  • Date*

Date Format: MM slash DD slash YYYY

  • Acknowledgement 1*

  • I have read and understand the Informed Consent section of this document.

  • Acknowledgement 2*

  • I have read and understand the Legal Disclaimer section of this document.

  • Acknowledgement 3*

  • I have read and understand what constitutes an Emergency Situation.

  • Signature*

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