Tuned In Reiki - Distance Intake Form

Tuned In Reiki - Distance Intake Form
Your Name*

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Emergency Contact*

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Medical Questions
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Please list your medical condition(s):*
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Please explain what metal implants or surgical devices you have:*
General Questions
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What did you like or not like about your previous Reiki experience?
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What would you like for me to focus on during your session?*
Consent Agreement
I understand that Reiki is a simple, gentle, 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 treatement, prescribe substances, nor interfere with the treatement of a licensed medical professional. I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed healthcare professional for any physical or psychological ailment I may have. I understand that Reiki can compliment 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.
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Tuned In Reiki - Distance Intake Form

Medical Questions

General Questions

Consent Agreement