In compliance with the Illinois Veterinary Medicine and Surgery Practice Act of 2004, the following information is being provided to you as the “owner or agent of the owner: of the animal (s) for which consent and acknowledgement of this treatment therapy is being obtained.
I am not a veterinarian; I do not diagnose medical issues, offer medical advice, prescribe drugs, or perform surgery.
I understand that Reiki and Shamanic healing are a stress reduction and relaxation technique. I acknowledge that treatments are administered for the purpose of enabling well being and promoting wellness to bring the mind and body into a balanced state.
Reiki and Shamanic practitioners do not diagnose conditions, or perform medical treatment, nor interfere with the treatment of a licensed medical professional.
It is recommended that I see a licensed physician or licensed health care professional for any physical psychological ailment I may have, and my animal companion see a licensed professional veterinarian for any health issues.
My role is that of a Reiki / Shamanic practitioner assisting your animals to relax and promote energetic well being. I will convey any intuitive telepathy (translation / interpretation of pictures, thoughts, and emotions from the animal (s) with energetic modalities such as Reiki or Shamanism to provide individualized assistance for dogs, cats, horses, birds, and other companion animals, along with their humans.
These services are not an alternative to or substitute for good veterinary care, proper nutrition, training, or exercise. Name: ____________________________________ (Reiki Practitioner) Address: __________________________________ City/State/Zip: _____________________________ Phone: ___________________________________ Email: ____________________________________
CONSENT AND ACKNOWLEDGEMENT OF TREATMENT/THERAPHY
I have read and understand the above disclosure statement pertaining to the services provided. I understand that he/she is not a veterinarian, her services are not to be considered as veterinary medical treatment, and the comments, suggestions, or recommendations proffered are not to be construed as veterinary medical advice. I (owner or agent of the owner) agree to have this service for my animal (s) and give my consent by signing below, in compliance with the Illinois Veterinary Medicine and Surgery Practice Act of 2004. I agree that the Reiki practitioner will not be liable for any damage or loss caused by my animal (s). Their behavior now and in the future is solely my responsibility. Should any behavior by my Animal (s), now or in the future, result in damage to the property, owners, or persons of a third party, I agree to assume full liability to such third party for any such damage, and hold harmless the Reiki practitioner.