top of page
Anchor 1
Reiki Healing Consent Form
  • I, Stephanie Sump, am a certified Master Level III Reiki Practitioner. Reiki is a simple, non-invasive, gentle, energy healing modality that works through energy blocks in the chakra system. When the chakra system has long term blockages or imbalances it can relate/correlate to several mental and physical health concerns. The benefits of reiki include relaxation, stress reduction and can promote the body’s ability to heal itself. Other energy divination tools such as crystals and tarot/oracle cards may be utilized in session, this will be done at the practitioner’s discretion. Any and all intuitive and/or energetic information that comes to the practitioner during the session will be discussed with and provided to you.

  • Please direct any and all questions or concerns that you may have to the practitioner before the start of the session.  

  • Reiki does not diagnose mental or physical conditions, prescribe or perform medical treatment or interventions, prescribe substances or medications and does not interfere or take the place of medical care from a licensed health care professional for any physical or psychological conditions you may have.

  • If you have medical or mental health concerns it is still recommended to seek medical care from a licensed medical professional. Reiki is a great addition to a healthy lifestyle for a holistic health and wellness approach.

  • I, Stephanie Sump, and The Traveling Therapist, LLLPC will not be held liable or responsible for any health/medical issues, problems, conditions, diagnosis or results.  

  • Confidentiality: Nothing discussed or covered in the reiki session and none of your personal information will be discussed or shared with any third/outside party.  

  • *To further promote relaxation the practitioner may utilize sage spray, incense, candles, or essential oil vaporizer in session.  Please notify the practitioner if you have any allergies.

  • *  Appointment Scheduling: Appointments will ordinarily be 50 minutes in duration, as frequently as we determine necessary or desired. The time scheduled for your appointment is assigned to you and you alone.

  • You are responsible for coming to your session on time; if you are late, your appointment will still need to end on time. There are some very appropriate, unavoidable reasons to cancel or reschedule an appointment with less than 24 hours’ notice, including (but not limited to) sickness, traffic circumstances, financial issues, and last-minute schedule changes.

  • If you do need to cancel your scheduled appointment with less than 24 hours’ notice without a reasonable explanation, please be prepared to provide full compensation for the appointment. In order to facilitate this, please provide your credit card information for us to keep on file. It will be stored securely, and you will be notified via phone prior to any charges for no-show appointments.

  • Professional Fees: You are responsible for paying at the time of your session unless prior arrangements have been made. Acceptable forms of payment include cash, or credit card.

  • Insurance does not cover the cost of Reiki.  (Stephanie Sump’s Reiki fee: $85 per session)

  • Consent: By signing this document, you are acknowledging that you understand and agree that you are mentally competent in requesting Reiki services by the practitioner Stephanie Sump. You understand that all modalities, treatments and readings will not be used to replace conventional medical practices, diagnosis, treatments and psychological or professional counseling, therapy or treatment and you will provide any changes or concerns of your medical condition to your healthcare provider.

  • You agree and understand that, Stephanie Sump, and The Traveling Therapist, LLLP will not be held liable or responsible for any health/medical issues, problems, conditions, diagnosis or results. Lastly you agree that you are the only one responsible for your life and its direction, therefore, any guidance, advice or intuitive information will be implemented or not by your choice and of your own free will. Stephanie Sump and The Traveling Therapist, LLLP will not be held liable or responsible for any life occurrences, decisions, or repercussions based on your decision to implement or not the information provided in sessions or readings. 

Thanks for submitting!

bottom of page