Reiki Intake Form


DISCLAIMER: The Rice University Recreation Center provides recreational programming and information for educational purposes. Please consult a healthcare professional before beginning this or any other fitness or recreation program to determine what is best suited for you and your needs. If at any point you begin to feel faint, dizzy, any physical pain, or shortness of breath, please stop participating immediately and if symptoms persist, call your health care provider or 911 in the case of an emergency.

Reiki Pricing

Reiki Pricing

SESSION TYPE STUDENT, STAFF, FACULTY MEMBERS STUDENT, STAFF, FACULTY NON-MEMBERS ALUMNI, COMMUNITY REC MEMBERS GENERAL PUBLIC
Single Reiki Session $55 $60 $65 $75

Screening Questionnaire

Screening Questionnaire

Carefully read and answer the following questions. All information will be kept confidential.

Have you had a Reiki session before?
Please check any condition that applies to you (check all that apply).
As Reiki is an energy, it could have an affect on a pacemaker. We can safely work around this.
Reiki is safe during pregnancy, however we advise to wait until after the first trimester.
It is possible that it can cause feedback or loud noises through a hearing aid - if you wear a hearing aid, please remove during the session.
Do you any allergies or skin sensitivities to perfume/fragrances, latex gloves, oils, lotions, or ointments?

Reiki Policies and Agreement

Reiki Policies and Agreement

Reiki Policy

Reiki will be prepaid and payment is due at the time of initial appointment. Check, cash, or credit cards are accepted forms of payment, either on the website or in the Recreation Center administrative offices. Make checks payable to Rice University. Paying a Rice Recreation Health & Wellness Staff Member directly is strictly prohibited; all membership privileges to the Gibbs Recreation Center will be terminated if this is violated.

Session Duration

Sessions are typically 45-60 minutes.

Refund Policy

Reiki sessions are non-refundable.

Transfer Policy

All Reiki sessions are non-transferable. All sessions must be paid in full and submitted to the Gibbs Recreation Center Administrative Office.

Late Policy

Reiki clients are responsible for arriving in a timely manner to their scheduled session. The Reiki practitioner is required by policy to wait 10 minutes beyond the scheduled start time before the service is forfeited. If a client's Reiki begins late due to the client's late arrival, the Reiki practitioner continues with the session and ends at the scheduled time.

Cancellation Policy

Except in the event of an emergency, a minimum of 24 hours notice is required for the cancellation of a massage therapy service. Failure to cancel within 24 hours or failure to show up for a session will result in a forfeit of the session. Exceptions will only be made in the case of a medical emergency accompanied by a doctor's note. If there should be a discrepancy, the decision will be determined by the Senior AD of Health and Well-Being.

Policy Agreement

Participation Agreement and Assumption of Risks and Liability

Participation Agreement and Assumption of Risks and Liability

desire to participate in the activities and programs of the Barbara and David Gibbs Recreation and Wellness Center (the "Activities") and, in consideration of being allowed to participate in the Activities and to use the machinery and equipment of the Barbara and David Gibbs Recreation and Wellness Center (the "Facilities"), I do hereby acknowledge and agree as follows.

1. I am fully informed and aware that my participation in the Activities and use of the Facilities involve certain risks, including, but not limited to, property damage and loss, bodily injury, illness and even death. I fully assume any and all risks.

2. I am in sufficient physical and mental health to participate in the Activities and to use to Facilities. I have medical insurance coverage appropriate for my participation in the Activities and use of the facilities, and I have provided medical insurance and emergency contact information below my signature on this agreement. I understand that Rice University shall not provide any insurance for me in connection with my participation in the Activities or use of the Facilities.

3. I fully and forever release, waive and discharge, and covenant not to sue Rice University (including but not limited to, its trustees, faculty, staff, students, agents, and representatives), from and for any and all demands, claims, actions, suits, damages, losses, liabilities, costs and expenses (including, but not limited to, court costs and attorneys' fees), from any cause whatsoever (including, but not limited to, property damage or loss, bodily injury, illness, or death) directly or indirectly arising in connection with my participation in the Activities or use of the Facilities, whether or not foreseen or contributed to by the negligent acts or omissions of Rice University or others.

4. This Agreement constitutes the entire agreement, and supersedes any prior or contemporaneous agreements, regarding this subject matter. The Agreement (i) may not be amended, by course of conduct or otherwise, and (ii) may not be assigned, in whole or part, except in writing duly executed by Rice University. This Agreement shall be interpreted and enforced in accordance with the laws of the State of Texas, without regard to any conflicts or choice of law principles, and shall be as broad and inclusive as permitted by such laws. If any provision of this agreement is held unenforceable by a court, such unenforceability shall not affect and other provision, and this Agreement shall be construed as if such provision, to the extent of such unenforceability, had not been incorporated herein.

5. I (i) have read and fully understand this Agreement, (ii) intend that this agreement be legally binding upon and enforceable against me and my family, estate, heirs, and legal representatives, (iii) intend that this agreement benefit Rice University, (iv) confirm that I am at least 18 years of age, fully competent, and am entering into this Agreement voluntarily and of my own judgment.

Assumption of Risks and Liability