Reiki Intention Form

Reiki Intention Form

This form helps me understand where you’re at and whether Reiki with me is a supportive fit.
First Name*
Last Name*
What are your pronouns?

She/HerHe/HimThey/Them
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Which Session do you feel is right for you?*

In-Person Reiki Session (60 mins) $99Distant Reiki Session (30 mins) $44
Have you received Reiki before? (It's okay if you haven't - this helps me know how to guide your experience)*

YesNo
Here's what you can expect...

Reiki sessions are quiet, intentional, and deeply personal. Whether we're meeting in person or from a distance, you'll be invited to rest while I focus on helping you release energy that's no longer serving you. You may feel warmth, tingling, emotion - or nothing at all. Every session is different, and that's ok. There's no "right" way to experience this work.
What was that experience like for you? *
What’s drawing you to Reiki at this time? (This could be anything, there is no wrong answer)*

StressBurnoutEmotional ReleaseCuriositySpiritual ConnectionOther
Are there any themes or areas you'd like me to focus on - or anything that's been feeling heavy, stuck, or unsettled?*

Physical TensionEmotional OverwhelmEnergetic ShiftsI'm unsure and would like guidanceOther
Is there anything else you'd like me to know about your intentions or expectations for Reiki? (This helps me make sure we're aligned before moving forward.)
Client Policies

Reiki sessions require at least 48 hours’ notice for cancellations or rescheduling. Cancellations with less than 48 hours’ notice may be charged 50% of the session fee. No-shows will be charged in full. If you're feeling sick or unwell, please reach out—we’ll reschedule with no fee.

Discriminatory or disrespectful behavior is not tolerated. This is a space of safety, care, and mutual respect.
Client Agreement & Policies*

I understand and agree to the cancellation, no-show, and conduct policies listed above.
Consent Confirmation*

I understand that Reiki is a complementary, energy-based practice and not a substitute for medical care.
Signature*

Clear
By signing, I confirm that I have read and agree to the above policies and all other selections made in this form.
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