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Below please find consent for Reiki services, with legally mandated information about Reiki. You must agree to it in order to receive Reiki at Reiki MD and San Diego Reiki (only required for new clients.) You can print this page for your records. Please let us know if you have any questions.
Pursuant to California Bill SB 577, practitioners of complementary wellness modalities, such as Reiki, must disclose the following information to each Reiki client:
I consent to Jikiden Reiki services provided by Dr. Maria Danilychev, MD and other Reiki practitioners at Reiki MD / San Diego Reiki.
I understand that Jikiden Reiki is not meant to treat or diagnose any medical condition, and that Jikiden Reiki is not a substitute for medical treatment or medications.
I understand that it is my responsibility to maintain a relationship with a medical doctor and/or another licensed healthcare provider.
I understand that Jikiden Reiki may include light touch and I consent to the touch and agree to let the Jikiden Reiki practitioners know before my session begins if there are any areas of the body that I do not want to be touched.
I understand that Jikiden Reiki is not a massage.
I confirm that I will be at least 18 years of age at the time of the appointment, or if I am less than 18 years old I will be accompanied by a parent or legal guardian.
I consent to receiving telephone, text, and email communication from Reiki MD / San Diego Reiki regarding services provided. I understand that I can opt out of receiving text messages at any time by replying “STOP”.
THIS IS A WAIVER & RELEASE OF LIABILITY, TO WHICH YOU WILL BE BOUND, AND UNDER WHICH YOU WILL BE WAIVING IMPORTANT LEGAL RIGHTS.
DO NOT SIGN THIS AGREEMENT BEFORE YOU READ IT.
By agreeing to this waiver, you are waiving any claim for personal injuries, including those arising out of the negligence of Dr. Maria Danilychev, MD and San Diego Reiki/Reiki MD LLC, and it’s employees, contractors, students, volunteers, agents, owners, tenants, landlords, visitors, and affiliates.
This release of liability does not apply to gross negligence, recklessness, and intentional acts.
By signing this form I assume any and all risks that may be associated with receiving Reiki services from Dr. Maria Danilychev, MD and from other Jikiden Reiki practitioners or teachers at Reiki MD and San Diego Reiki.
I understand that it is recommended that I maintain a relationship with licensed healthcare professionals while I receive Reiki services.
I assume any and all risks of injury associated with or in any manner related to my use of or presence upon the Japanese Friendship Garden premises.
I assume any and all risks of injury associated with or in any manner related to the use of massage tables and other supplies, props, or furniture, utilized during Reiki sessions. This waiver applies regardless of whether or not I use the massage table or other supplies, props, or furniture at the time of the injury or whether my injury occurs as a result of my presence upon the premises regardless of purpose or activity at the time of the injury-causing incident.
I agree and covenants not to sue or otherwise attempt to hold Dr. Maria Danilychev, MD and Reiki MD LLC and San Diego Reiki, and it’s employees, contractors, students, volunteers, agents, owners, tenants, landlords, and affiliates liable for any injuries or changes in physical or mental health conditions regardless of the cause.
I agree to indemnify and hold Dr. Maria Danilychev, MD and San Diego Reiki/Reiki MD LLC, and it’s employees, contractors, students, volunteers, agents, owners, tenants, landlords, and affiliates harmless against any and all claims arising out of the my presence upon the premises of San Diego Reiki/Reiki MD, LLC including the use of the premises by any family member or guest regardless of cause.
This waiver and release agreement is intended to be as broad as is allowed under the applicable law and applies to any and claims for damages, regardless of whether they are allegedly caused by the negligence of Dr. Maria Danilychev, MD and San Diego Reiki/Reiki MD LLC, and it’s employees, contractors, students, volunteers, agents, owners, tenants, landlords, and affiliates.
This waiver and release agreement applies to all injuries including, but not limited to, slipping at Reiki MD / San Diego Reiki or one of its facilities, injuries caused by malfunctioning massage tables, chairs or any other equipment, building construction, and/or any other potential hazards that may be present before, during, or after I receive Reiki services at Reiki MD / San Diego Reiki.
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