Reiki Intake
Please fill out this brief intake form . This intake form is private and details will not be shared. I will contact you through the email address you have provided to schedule your appointment. I look forward to our time together. Namaste.
Are you familiar with Reiki or energy work?
Yes
No
First Name
*
Please note you will need to provide I.D at your appointment that matches this name.
Email Address
*
Phone Number
*
Age
What draws you to energy work at this time?
What are you hoping to explore or heal through reiki/energy work?
*
Have you previously received any form of energy work? If so, describe your experience.
Which of the following best reflects your understanding of this practice?
Reiki is a spiritual and energetic practice that focuses on energy flow, mindfulness, sacred touch, breathwork, intention and emotional release.
Reiki involves massaging of the body
I'm not sure but I'm open to learning.
Are you aware that this service does not include sexual acts ?
Yes
No
Is there anything else you'd like me to know about your goals or expectations?
I acknowledge that I understand the nature of this practice and agree to respect the boundaries of the practitioner.
Yes
No
Submit
Should be Empty: