Client Intake and Consent - Reiki

  • Client Intake & Consent

    Reiki Services

  • Thank you for choosing to share your energy and space with us. We are honored to support you as you reconnect with your body’s natural rhythm and innate wisdom.

    Reiki is a gentle, restorative practice designed to support your nervous system and promote deep relaxation. Whether you are seeking emotional clearing, physical rest, or a moment of stillness, our goal is to provide a grounded sanctuary where you can rediscover what it feels like to be at your very best.

    Please fill out this form with as much detail as you feel comfortable sharing. This helps us tailor our session to your specific intentions and ensure you feel fully supported. If you have any questions before we begin, please don't hesitate to ask.

    • General Questions 
    • Have you received services with us before?*
    • Date of Birth*
       - -
    • General - Optional 
    • Format: (000) 000-0000.
    • Gender*
    • Format: (000) 000-0000.
    • Intro 
    • Have you ever received this type of professional session before?*
    • What is your primary intention for this session?*
    • Reiki can be performed with light physical touch or by hovering hands slightly above the body. Which do you prefer today?
    • Are you sensitive to any of the following?
    • On a scale of 1-10, how would you rate your current stress level?
    • To best serve you, how do you like to receive feedback?
    • Health and Safety 
    • Are you currently pregnant?

    • Consent to Treatment of Minor: By submitting this form, I hereby authorize the practitioner to administer reiki techniques to my child or dependent as they deem necessary.

    • Late/Cancellation Policy
      Please arrive at least 5 minutes* before your scheduled appointment time in order to ensure a full massage session. * If you are a new client, then you will need to arrive 5-10 minutes early to go over paperwork. Clients arriving late will receive the rest of their appointment time and will be charged for the full scheduled appointment time. Clients arriving more than 15 minutes late will be rescheduled. You may cancel your appointment without charge 24 hours before your appointment. Cancellations less than 24 hours before session will be charged 25% of the scheduled service; less than 12 hours will be charged 50%. • If you do not call to cancel your appointment or do not show up for your scheduled appointment, you will be charged 100% for the scheduled service.


      Sick Policy
      Both practitioners and clients are vulnerable to infection from contagious illnesses. If you come in sick, it can worsen your condition. Please reschedule your appointment if you are feeling unwell. Clients with any of the following illness, or any other contagious illness not listed, will be rescheduled: Vomiting, fever, cold, influenza, diarrhea, measles, mumps, rubella, chicken pox, head lice, scabies, impetigo, meningitis, conjunctivitis, hepatitis A, thrush, polio, ringworm of the body, feet or scalp, meningococcal disease, and whooping cough.

    • Liability Waiver & Consent 

    • I understand that Reiki is a gentle, complementary energy practice intended for relaxation and stress reduction. I acknowledge that my practitioner is not a licensed physician and does not diagnose conditions or prescribe substances. I understand that Reiki is not a substitute for medical or psychological care. I voluntarily choose to receive this session and assume full responsibility for my wellness during and after the appointment.

    • Signature 

    • Services are provided by Beni Massage and Wellness LLC, operating under the name “Béni Massage and Wellness.”

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