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Reiki-Infused Breathwork & Sound Bath

Please complete this form before your first Reiki session.

Thank you for joining us for this Reiki-Infused Breathwork & Sound Bath experience.

This offering combines conscious breathwork, Reiki energy healing, sound healing, meditation, and guided relaxation practices to support stress reduction, nervous system regulation, self-awareness, and overall well-being. Every participant's experience is unique. Some people feel deeply relaxed, while others may experience physical sensations, emotional release, insight, or a greater sense of clarity and connection.

Please take a few moments to complete this form so we can create a safe, supportive, and comfortable experience for everyone. All information shared will be kept confidential and used only to support your participation.

Have you participated in Breathwork, Reiki, or Sound Healing before?
Yes
No
To support your well-being during this experience, please share any relevant health information by checking all that apply:
Reiki may involve light, gentle touch or may be done completely hands-off. Please check all that apply:

Consent & Acknowledgement

I acknowledge and understand that:

• Reiki, breathwork, sound healing, meditation, and related practices are complementary wellness modalities intended to support relaxation, stress reduction, self-awareness, and overall well-being.

• These practices are not a substitute for medical, psychological, or psychiatric diagnosis, treatment, or care.

• No specific outcomes or results are guaranteed.

• Participation may involve physical sensations, emotional release, energetic shifts, memories, or changes in awareness.

• If I have concerns about my physical or mental health, I am responsible for consulting with an appropriate healthcare provider before participating.

• I am responsible for monitoring my own physical, emotional, and mental well-being during and after the experience and will communicate any concerns to the facilitators.

• I may pause, modify, or discontinue my participation at any time.

• I understand that the facilitators are not licensed medical or mental health providers acting in that capacity during this event and do not diagnose, treat, prescribe, or cure medical or psychological conditions.

• I voluntarily assume all risks associated with participation in this event.

• I release, indemnify, and hold harmless Light, Love & Reiki (Amy Mew), Confluence Breath & Bodywork (Chris Thier), and Trebled Souls (Steph Radkay), and their owners, employees, contractors, volunteers, and representatives from any claims, liabilities, damages, injuries, losses, expenses, or legal costs arising from my participation in this event, except as prohibited by applicable law.


By signing below, I acknowledge that I have read, understood, and agree to the information above and voluntarily consent to participate.

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