I (the client) understand that Reiki, Reiki Drum and Indian Head Massage are Complementary Therapies for the purpose of deep relaxation and therefore are not to be used in place of seeking professional medical advice or treatment.
The Practitioner Jo Bourke has not made any claims or promises about any ‘healing’ abilities or made any claims or guarantees about any ‘results’ of treatments. The session is designed to be comfortable and for the purposes of relaxation.
I understand that for Reiki I will not be asked to remove any clothing other than shoes or outer items such as jackets etc to facilitate comfort when lying down. That at any time I can speak, move, stop the session at any time if I experience any discomfort or uncertainty at any point.
I understand that Indian head massage can include upper-middle to upper back, shoulders, neck, collarbone area, arms, hands, head – scalp, hair, ears, face – and that I have the option to request not to include any areas (such as face) to request not to use oils and to remain fully clothed. If I remain clothed I understand that oil cannot be used. If I use oil I will only be asked to remove clothing garments to expose the upper back and shoulder and a towelling wrap will be provided to be worn for the duration. It is advisable to wear two-piece clothing for this session as bottom half of clothing is worn at all times.
I the client have not withheld any information pertinent to my treatment session such as but not limited to: mental illness, pacemaker, pregnancy, chemotherapy, anxiety, depression or any injuries, pain or discomfort that could be unintentionally exacerbated by the treatment I have received.
I have been advised that if I suspect I may have a medical condition I should seek help from a qualified medical practitioner.
I confirm that the information I have given is true to the best of my knowledge and I have not withheld any relevant information.
I understand that all information will be treated in strictest confidence.
I confirm that Jo Bourke has fully explained the treatment and the procedures involved and I understand fully what is to happen during my session, that have not held back any questions, concerns etc.
I understand that at all times my personal body privacy will be maintained.
I confirm that the details given by me to the practitioner are correct and that if any of the personal information given changes, then I accept that I must inform her accordingly.
I have had opportunity to ask questions regarding the above and am willing to proceed with the treatment of a Reiki, Reiki Drumming, Indian Head Massage session. (Delete as applicable)
I understand the fee that has been discussed, that I have agreed to pay it in advance, that it is non-refundable after the treatment, and that the fee is in exchange of a 60/75/90 minute session. (Delete as applicable)
Data Protection
The changes in Data Protection Legislation that came into force on 25th May 2018 legally oblige me to provide you with the following information, and to ask you to give your consent for me to hold your personal data.
What is included under personal data?
The personal data I hold about you may include:
• Your phone number, email address, postal address.
• e-mails and e-mail attachments, SMS/Whatsapp messages we have exchanged.
• The initial Client Form which you have completed.
• Brief notes for each treatment session How do I store your personal data?
• Your initial client form is stored securely in a locked filing cabinet.
• Your phone number is stored on my mobile phone under your first name or initials (no surname is used), as are any SMS/Whatsapp messages and record of phone calls. My phone is code-locked and is kept secure at all times.
• Our e-mail correspondence is password-protected and my e-mail service provider ensures that the e-mails are secure and encrypted.
• Treatment session records are kept as hard copy in a locked filing box.
• Appointments are booked in my electronic calendar/diary with your first name only.
• Email addresses for the purposes of mailing lists and e-newsletters. This will be held by a third party database (Mailchimp) who are also responsible for your data protection. Other than the mailing list provider, your details will not be shared to any other party and will only by used for the purposes of sending you the newsletter and information you signed up to receive.
Why do I need to hold your personal data?
• In order to be able to communicate with you via phone, e-mail or post if necessary.
• So that I have a record of your attendance and a note of important factual information that may be of significance in our healing sessions.
• It is a requirement of my insurance provider.
How long will I keep your personal data for?
• My insurance provider requires me to keep any client records for 7 years after completing treatment.
• After 7 years from completion of treatment sessions, all electronic data will be permanently deleted, and any hard copies shredded and disposed of. Your right to see the personal data I hold about you
• The legislation states that you have the right to see the personal data I am holding about you.
• If you wish to do so, you can ask to see your personal data, and I will be required to provide this for you within 40 days of your request.
When may I share your personal information with third parties?
There are a limited number of circumstances in which I may share your personal data and other information with third parties:
• Where required by the court of law.
• If your safety or that of a vulnerable adult or child is imminently at risk.
• If you request and/or give me consent to share your information with another health professional for the purposes of improving your care.
• I may discuss some aspects of my client work with my supervisor who is an experienced practitioner also bound by the rules of confidentiality
Nature-focused, Shamanic Reiki Drum, Reiki & Reiki Massage, Forest Therapy 