Reiki Client Session Request
This form is a confidential document and will be reviewed and filed as such. The following questions are to gather information to support the Reiki session.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Can we text you?
Yes
No
Session length?
30min
60min
Have you ever had a Reiki session before?
Yes
No
Are you comfortable with touch?
(By Typing your name below you agree to the following statement) "I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions nor do they prescribe or perform medical treatment. I understand that Reiki does not take the place of medical or psychological care. I understand that Reiki can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself."
If you wish, please share the reason for the session below. Share any Physical, Emotional or Spiritual needs I should focus on for the intention of the session.
Submit
Should be Empty: