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
Are you request Reiki healing for a past, present, future, or upcoming event?
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?
Please mark any conditions that apply (past or present)

Other
Please mark any symptoms recently experienced? (Within the last two weeks)

Other
Please mark the areas that could use improvement

Other
Please insert a photo of the person receiving this distance healing

Browse Files

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Take Photo
How would you like your session feedback?
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