Animal Reiki Client Intake Form

Animal Reiki Client Intake Form
Welcome
Welcome. This form is intended to help me get to know your animal as an individual before our session.

There is no need to provide a diagnosis or focus only on a specific concern. The purpose of this form is simply to help me understand your animal’s personality, preferences, and unique qualities, so I can approach our session with care and understanding.

Please share whatever feels appropriate. Every animal is unique, and your responses will help me approach the session with openness, compassion, and respect.
Name

First NameLast Name
Email
example@example.com
Phone Number: Optional
Please enter a valid phone number.Format: (000) 000-0000.
Address (Required For In-Person Session)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
About Your Animal
Animal’s Name
What Is Your Animal’s Species & Breed (If Applicable)
Age
Male or Female
Getting To Know Your Animal
What’s Your Favourite Thing About Your Animal?
How Would You Describe Your Animal’s Personality?
Does Your Animal Live With Any Other Animal’s? If Yes, Your Welcome To Share A Little Bit About Them If You Feel Called To.
Your Session
Please confirm which type of session you have booked:
Supporting Your Animal’s Comfort
Is there anything I should know about your animal’s preferences, boundaries, or comfort around new people that would help me create a safe and respectful environment for the session? If there is nothing you feel I need to know, you can simply write “Nothing to add.”
If your animal has previously shown behaviour that may create a safety concern around unfamiliar people, please let me know before the session.

This may include previous attempts to bite or scratch, lunging, significant fear responses, or any other behaviour that you feel I should be aware of.

This information helps me respect your animal's boundaries and make appropriate arrangements for the session.

Where an in-person session may not be appropriate for safety or comfort reasons, Reiki will instead be offered as a distance session. This allows your animal's needs and boundaries to be respected while continuing to honour them as an individual.
Previous Reiki or Holistic Experience
Has your animal experienced Reiki or any other holistic or complementary practices before?
Follow Up Permission
Would you like me to contact you after the session to check in and see how your animal is doing?
Photo and Video Sharing Permission
With your permission, I may share photographs and/or videos of your animal on social media or other promotional materials to help others learn more about Animal Reiki. Sharing images or videos is completely optional and will only be done with your consent. You may withdraw your consent at any time by contacting me.
Testimonials
If you provide a testimonial, may I share it?
Privacy & Data Protection
Information provided through this form, together with relevant information shared before, during or after an Animal Reiki session, will be handled in accordance with the Privacy and Data Protection section of the Animal Reiki Terms & Conditions.

The Terms & Conditions explain how personal information may be collected, used, stored and retained, including information provided through email, social media, Jotform and other communication methods.

Please read the Terms & Conditions before completing this form.
Privacy acknowledgement
Animal Reiki Consent & Acknowledgment

Please read the following carefully before signing.
By signing below, I confirm that:
Reiki Chair Session Consent
Please tick if this is relevant to your session.
In-Person Session Safety
Please complete this section if you have booked an in-person session.
Agreement To Terms & Conditions
Final Acknowledgement & Signature
By signing below, I confirm that the information I have provided is accurate to the best of my knowledge and that I have had an opportunity to read and understand the information provided in this form and the Animal Reiki Terms & Conditions.
Guardian Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Animal Reiki Client Intake Form

Welcome

About Your Animal

Getting To Know Your Animal

Your Session

Supporting Your Animal’s Comfort

Previous Reiki or Holistic Experience

Follow Up Permission

Photo and Video Sharing Permission

Testimonials

Privacy & Data Protection

Animal Reiki Consent & Acknowledgment

Reiki Chair Session Consent

In-Person Session Safety

Agreement To Terms & Conditions

Final Acknowledgement & Signature