Full Name*Cell Phone*Email* Do you want to be added to my email list?YesNoDuring your session, I can communicate with family and friends that have crossed-over. Can you please list the people you would like to connect with and their relationship to you. (First Name Only)Do you have an addiction?Is there a person who has caused you significant trauma: (First Name Only)Do you have a particular area of concern?Please check the boxes to agree to the following statementsPrivacy Notice* I Agree. The information disclosed on this sheet and discovered during our session will not be disclosed to a third party. This includes family members or friends that may also be clients. All information is held Confidential Sessions can be recorded:* I would like my session recorded. I will email or drop box this to you at the time of the session. I DO NOT WANT MY SESSION RECORDED I need your permission to use the information gathered during our session together because I am writing a book, posting articles, creating podcasts, blog posts, Facebook posts, Instagram posts and creating this website. I DO NOT reveal specific names associated with the stories. I DO NOT reveal any personal, identifying information when sharing information gathered during our session* YES, you have permission to use my story and information learned during our session. I understand that the information shared from our session WILL NOT include my name or reference me in any specific way. NO, you DO NOT have permission to use the story or information learned during our session even if my name is not associated with the story. Payments I understand payments are due at the time of the session: $120 for 90 minutes. I accept cash, checks, PayPal or Venmo. I DO NOT take credit cards. Reiki is not a substitute for medical treatment* I understand that I understand that Reiki is an energy technique that is used for stress reduction and relaxation. I understand that an intuitive reading during the Reiki session and the Reiki are not a substitute for medical treatment. Alison B. Ledbetter will not diagnose, prescribe or perform medical treatments* I understand I understand that Alison B. Ledbetter will not diagnose, prescribe or perform medical treatments. Please seek licensed, medical, professional care for all physical and psychological ailments you have. Reiki is a complementary technique that does not interfere with medications and medical treatments. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. Alternative Balance Insurance I am Insured by Alternative Balance (contact@AlternativeBalance.org) Policy #: 1004 and Certificate #: AC106289 Signature*Date Date Format: MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.