New Client Take On Form Logo

  • NEW CLIENT INTAKE FORM

  • GP INFORMATION

  • Client health history

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  • Treatment Information

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  • I DECLARE THAT I HAVE NOT WITHELD ANY INFORMATION FROM THE REIKI PRACTITONER, I UNDERSTAND THAT THE REIKI IS NOT A SUBSTITUTE FROM MEDICAL OR PSYCHOLOGICAL DIAGNOSIS AND TREATMENT. IT IS RECOMMENDED THAT I SEE A REGISTERED DOCTOR OR HEALTH CARE PROFFESIONAL FOR ANY PHYSICAL OR PSYCHOLOGICAL CONDITIONS THAT I HAVE.

    • I understand that at all times my personal body privacy will be maintained, I am not required to remove any clothing except for my shoes
    • I understand that all the information will be treated in the strictest of confidence
    • The practitioner has fully explained the treatment and procedures involved
    • I have had the opportunity to ask the questions regarding the reiki treatment and am willing to procced.
  • Clear
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  • Should be Empty: