REIKI 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

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Have you ever had Reiki before?*

Yes, in personYes, by distanceNo

Do you have a particular area of concern?

What are your goals for receiving Reiki?*

If you indicated "Other," please elaborate:

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

If you are receiving reiki in person, are you sensitive to touch?

YesNo

How did you hear about Sora Holistic?

Reiki is a gentle 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.

Reiki practioners do not diangnosis conditions nor do they practice or perform medical treatment, prescribe substance, nor interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of medical care. Reiki can complement any medical or psychological care that I may be receiving.

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.

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