Divine Yemaya Distance Reiki Intake Form

Name

First NameLast Name

Birth Date

MonthDayYear

Gender

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState

Zip Code

File Upload

(Optional): Please upload a photo of the person receiving the Distance Reiki treatment

What are your goals for receiving Reiki?

Other

Is there any injuries, surgeries, or recent health conditions that you feel the need to share?

Pick a day for your 1st Distance Reiki Treatment at no cost to you.

Date

Hour MinutesAM/PM Option

Reiki is a healing technique that uses the universal life force energy to balance the subtle energies within our bodies to heal and contributes for balanced physical, mental, emotional, and spiritual being. Reiki is not a replacement for traditional medical treatment. During a Reiki session, your Reiki practitioner will lay their hands on your body in a series of hand positions to deliver Reiki energy. You might feel a floating sensation, emotional release, increased relaxation, enhanced sense of balance, centeredness, and calm. The effects of Reiki are cumulative in which regular Reiki treatments can invite significant improvement. Regular sessions support well-being in every way. If you experience any pain or discomfort during this session, immediately inform the practitioner.

The distance symbol is used to cross any distance in time or space. It allows practitioners to clear blockages from someone's past, as well as perform reiki on someone who is not physically present. Distance Reiki works according to an ancient principle called the Hermetic Law of Similarity, which holds that we are all connected, as we are all made of energy and part of a larger whole. Invoking this law during a distance Reiki session allows the practitioner to link up to the energy field of the recipient.

Please sign below if you acknowledge the given information and give your consent to recieve the treatment.

My Products

1 Treatment per week/ 1 Month (1 Hour)

After your first free treatment you can subscribe to 1 treatment per week for 1 month, 2 treatments per week for 1 month, 3 treatments per week for 1 month and 4 treatments per week for 1 month. All treatments are for one hour. All consent forms and information about your session will be sent via email. After you pay for your treatments you can pick the days and times you would like your treatments done.

$100.00 Quantity
Item subtotal:

Total

Pick your day for your (paid) Distance Reiki Treatment. All treatments will begin on the day you pick and daily after that at the same time according to your subscription.