True-Self Alignment Session Client Intake Form

True-Self Alignment Session

Client Intake Form
Name

First NameLast Name
Birth Date

MonthDayYear
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about my services?
Have you ever had a Reiki session?

YesNo
If yes, what was your experience like?
Have you ever had a Tarot reading?

YesNo
If yes, what was your experience like?
Are you currently having to cope with any pivotal shifts or transitions in your life? (i.e. relationships, relocating, loss, children, career change, etc.)
What led you to seek this mystical offering?
Are you comfortable with light touch during the Reiki session? *(please indicate if you prefer hands-off treatment)

YesNo
Do you have any difficulty lying on your back for the duration of the Reiki session?

YesNo
In which area of your life do you feel most out of alignment?

SpiritualityWork/CareerRomantic RelationshipsPhysical HealthLife Path/PurposeOther
If "other", explain:
Is there any injuries, surgeries, or recent health conditions that you feel the need to share?
Your custom talisman will be created intuitively and WILL TAKE 8-12 WEEKS TO COMPLETE (spring & fall are especially busy seasons for me. I'm also a single parent so I appreciate your patience). Please list any any size preferences and elements you do/don't prefer to be incorporated in the design (i.e. bones, crystals, twigs, leaves, flowers, etc.)
What is your availability? (After receiving your form I will contact you to schedule your session)*

Monday Morning/AfternoonTuesday Morning/AfternoonWednesday Morning/AfternoonThursday Morning/AfternoonFriday Morning/AfternoonSaturday Morning/AfternoonSaturday EveningSunday Morning/AfternoonSunday Evening
The energy exchange for this service is $222.

A non-refundable $100 deposit is required to secure your appointment.

Cancelations require at least 72 hour prior notice or an additional cancelation fee will be billed to the client (unless due to sudden illness or emergency, in which case a new appointment date will be scheduled).

Cancelation fee is an additional $50.

No call/no shows pay the additional cancelation fee of $50 and future appointments will be prohibited.
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.

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.
Signature*
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