FREE Reiki Session Inquiry Questionnaire

FREE Reiki Session Inquiry Questionnaire
Thank you for your interest in a free 30-minute Reiki session. We aim to support individuals in need during challenging times. Please fill out this questionnaire to help us understand your needs better.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Please describe your current health status:Briefly outline any serious health concerns, including any recent diagnoses (e.g., cancer, chronic illness).
Are you currently receiving treatment for your condition?

YesNoOther
Are you able to receive Reiki sessions in-person, or would you prefer a remote session?

OnlineIn-personBoth
Have you had any previous experience with Reiki or energy healing?

YesNo
Why do you feel you would benefit from a Reiki session?(Please describe your current challenges, both physical and emotional.)
Do you have any specific goals or intentions for the session?(E.g., stress relief, pain management, emotional support)
Are there any specific health conditions or concerns we should be aware of?(Allergies, mobility issues, etc.)
What is your preferred timing for the session?(Days and times you are available)
I understand that Reiki is a complementary therapy and not a substitute for medical treatment.

YesNo
Do you consent to the session and provide your information for follow-up?

YesNo
Thank you for completing the questionnaire. We appreciate your willingness to share your information, and we will review your responses to determine how we can best support you.

Kindly Elizabeth

Oneness Healing LLC
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FREE Reiki Session Inquiry Questionnaire

Thank you for your interest in a free 30-minute Reiki session. We aim to support individuals in need during challenging times. Please fill out this questionnaire to help us understand your needs better.