Reiki intake Form

We love creating personalised Reiki experiences for you. 

Sharing more about yourself helps us create something unique to you as we take into consideration your needs.


Mirosuna wants to support you to create space for change. We welcome you to find more meaning in your everyday life through our multi-sensory relaxation experiences.

I understand that all services/healing modalities, including Reiki, offered by Mirosuna may have positive or negative side effects as a result of treatment.

I accept legal responsibility for my choice to receive these treatments and waive the responsibility of the practitioner and the facility where the sessions take place in the case that any side effects discussed (or others) may occur.

I affirm that I have stated all of my known medical conditions, and answered all questions accurately, completely, and honestly.

I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s part should I forget to do so.

I understand that I am receiving treatment at my own risk and hereby release the practitioner from any liability.

I understand that all sessions offered Mirosuna include complimentary therapies/modalities and that I will not be provided medical advice, prescribed or diagnosed during our sessions.

I agree that I have read, understood and fully agree to the terms of this waiver and release, and understand and confirm that by signing this waiver and release, I am giving up considerable future legal rights.