I acknowledge that I am voluntarily participating in sessions that may include
relaxation techniques, guided visualization, hypnosis, and/or stress-
reduction practices. I understand that these modalities are holistic and non-
medical in nature, and are not intended to diagnose, treat, or cure any
physical or mental health condition. I accept full responsibility for consulting
with my primary care physician or licensed healthcare provider regarding any
current medical conditions, symptoms, or changes to my health or
medication. I understand that the services provided by Dena Ortiz/Divine
Reiki-Breath Spiral are intended as complementary support and are not a
substitute for professional medical or psychological care. I acknowledge that
all healing is ultimately self-healing, and that Dena Ortiz/Divine Reiki-Breath
Spiral serves only as a facilitator in supporting my personal healing and
transformation. I accept full responsibility for any personal growth or changes
that may result from these sessions, recognizing that the outcome depends
on my own active participation, openness, and honesty. I agree to
communicate truthfully and provide relevant information during all sessions
to support the effectiveness of the process. I understand and agree that Dena
Ortiz/Divine Reiki-Breath Spiral shall not be held liable for any form of
negligence or perceived harm, as I enter into this work as a sovereign
individual, fully responsible for my own healing and well- being.
Client Full Name (Printed): ___________________________________________
Client Signature: _________________________________________
Date: ___________________________

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Please download and email signed copy to reikiwithdena@gmail.com

A signed copy must be returned prior to the start of any session.

Thank you.