Animal Reiki Intake Forms

Your Name*

First NameLast Name

Phone Number

Area CodePhone Number

Email*

Animal Companion's Name*

Species (Dog, Cat, Horse, etc)

A photo will help connect to the energy of your pet. Can you provide one?

YesNo

Please upload your pet's photo below or email to KatieLRow@gmail.com - your pet should be the only subject in the photo and should be looking at the camera so the eyes can be seen (if possible). The more recent, the better.

Browse Files

What is the main issue? Why are you wanting your animal companion to receive Reiki sessions?

Any information on veterinary treatment, medication, or other health treatments you would like me to know about? Any particular areas of the body that should be noted?

Can you describe what a typical day looks like for your animal? (Sleep schedule, activity types and duration, contact with other animals, diet information that might be relevant, amount of time you spend with them, where they go (kennel, park,etc) can be helpful if you choose to share.

Is there anything else you would like me to know about your pet?

I,   First Name   Last Name  , understand that the Reiki session(s) for my animal companion   Pet's Name  , is intended to provide relaxation, reduce stress, promote overall health and well-being. I understand that Reiki practitioners do not diagnose conditions, prescribe veterinary medication, perform medical treatment of any kind or interfere with the treatment of a licensed veterinarian or other medical professionals.
Initials      I understand that Reiki is not a substitute for veterinary care or medicine but may compliment any veterinary care my pet is receiving. I agree I will inform my veterinarian and practitioners of any health changes prior to future appointments.
Initials   I understand that the safety and care of my animal is ultimately my responsibility
Initials   I understand that the sessions are total voluntary, and I may choose to end the session for my animal at any time.
Initials   I acknowledge that long-term imbalances may sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.
Initials   I understand that the reiki practitioner is providing Reiki at my request and are not responsible for the outcome of the session. The animal directs the treatment and therefore session length and results vary per each session.
Initials   I understand that Reiki can speed the healing process. I will monitor my animal companion and provide plenty of water and space after the session.

Cancellation Policy: I understand that there are occasions when you may have to reschedule/cancel a session. I request that you let me know as soon as possible if you need to cancel, but at least 24 hours in advance so that we may offer that time slot to another.

I First Name Last Name authorize Katie Rowland with StarzyKat's Grove to offer Reiki Session(s) to my animal Companion

Signature

Animal Reiki Intake Form

Animal Reiki Waiver