Welcome to Your Reiki Healing Session!
Client Information
Name
First Name
Last Name
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Health Information
Please answer the following question to the best of your knowledge:
Do you have any medical conditions or concerns that you believe may affect your ability to receive Reiki treatment? (e.g., heart conditions, epilepsy, pregnancy, etc.)
Yes
No
If yes, please provide details:
Reiki Intention
Have you ever had Reiki before?
Yes
No
How did you hear about Reiki Flo?
What is your main reason for seeking Reiki at this time?
What are your specific goals or intentions for the Reiki treatment?
Reiki Session Preparation
Do you have difficulties lying on your back for the entire session?
Yes
No
N/A - Distant healing
Are you sensitive to perfume or fragrances?
Yes
No
N/A - Distant healing
Are you sensitive to touch?
Yes
No
N/A - Distant healing
Reiki treatment can be done fully hands-off or hands-on respectfully (such as feet, shoulders, knees for example). Please indicate your preference:
Fully Hands-off
Ok with hands-on
N/A - Distant healing
Is there anything you would like your Reiki practionner to know before beginning?
Reiki Treatment Consent
Please review the following information prior to your Reiki session:
Purpose:
Reiki is a gentle, holistic energy technique that promotes relaxation and overall well-being.
Medical Disclaimer:
Reiki is not a substitute for medical or psychological care. Your Reiki practionner does not diagnose, prescribe, or perform medical treatments. You are encouraged to seek adequate diagnosis and treatment from a licensed healthcare professional.
What to Expect:
The practitioner may place hands lightly on or just above your body. Any touch will be professional and respectful.
Possible Reactions:
Generally safe; some may experience mild warmth, tingling, or emotional release. Notify your practitioner of any discomfort.
Confidentiality:
All information shared is confidential, except as required by law.
I acknowledge that I have read and understood this information and consent to receive Reiki treatment.
Yes
No
Date Completed
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Day
-
Month
Year
Date
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