Need assistance at a distance?

Remote Reiki Request

Please provide the following details prior to your first Reiki treatment.
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.
Are you requesting Reiki healing for yourself or someone else? *
Patient Name*

First NameLast Name
Patient Age
Guardian Name (If patient is under 18)*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
I am requesting Reiki for a traumatic or painful experience that I or a loved one needs healing from in the past.I am requesting Reiki for an important event coming soon! (Please provide date, time, and details below)I am requesting Reiki to align my chakras or those of a loved one and improve current state of wellbeing.
Patients Concerns (Please rate 1-10; 1 being hardly noticeable & 10 being unbearable)*
Medications/Remedies/Supplements & Reason(s) for taking:*
Any allergies, surgeries, medical diagnosis’, genetic disorders, or phobias?*
CancerHeart diseaseDiabetesStrokeEpilepsyVaricose veinsH/L blood pressureParalysis/sleep paralysisArthritisAnxiety/depressionNoneOther
HeadacheDizziness/faintingTightness in jaw/teeth grindingWeak body partsSmokingNervousnessPoor appetite/indigestionHeavy feeling in chest/limbsBlurry vision/stigmatismConstipation/loose bowel movementsHeart palpitations/chest painsInsomnia/fatigueCold hands/feetUpper/lower back painNeck/shoulder painMenstrual pains/irregularitiesPregnancyOther
Negative self-talk/self-sabotagePessimism/anger/depressionAchieving goals/manifestingAbility to dream/remember dreamsProblem-solving/taking actionEliminate procrastinationLose/gain weightStrengthen memory/concentrationAddiction/breaking habitsReleasing trauma/heartacheNoneOther
Please insert a photo of the person receiving this distance healing

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Please check the email provided for booking to access your PDF downloads to follow along with and reflection prompts for after your treatment.
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Remote Reiki Request

Please check the email provided for booking to access your PDF downloads to follow along with and reflection prompts for after your treatment.