Reiki Client Information Form

Reiki Client Information Form

This is form is a confidential document and will be reviewed and filed as such. The following questions are to gather information to support the Reiki service.
Name*

First NameLast Name
Birth Date*

DayMonthYear
Email*
example@example.com
Phone Number （WhatsApp)*
Please enter a valid phone number.Format: (000) 000-0000.
WeChat / LineID (optional)
Choose your Appointment (Estimated 1.5 hours per session)*
YESNO
Pain reliefRelaxationAddressing a traumaOther
Is there any injuries, surgeries, or recent health conditions that you feel the need to share?
If you wish, please share the reason for the session below. Share any Physical, Emotional or Spiritual needs I should focus on for the intention of the session.
Reiki is a healing technique that uses the universal life force energy to balance the subtle energies within our bodies to heal and contributes for balanced physical, mental, emotional, and spiritual being.
- I understand that Reiki is a simple, gentle, hands-on 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 treatment, prescribe substances, nor interfere with the treatment 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 health care professional for any physical or psychological ailment I may have.
- I understand that Reiki can complement 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.
(Please type your name below if you acknowledge the given information and agree to the statement)*
Your Full Name
Should be Empty: