Reiki Intake Form

Thank you for allowing me to help you with Reiki energy healing.

Let's get the logistics out of the way so you can fully enjoy your healing session.

* Complete this form and the payment energy exchange 24 hours prior to your session

* Carefully review the terms and conditions

I read, understand, accept the terms & conditions and agree to proceed

First and Last Name

Email

Emergency Contact

Have you had a Reiki session before?

If yes, how many previous Reiki sessions have you had?

When was your last Reiki session?

What do you hope to experience in your Reiki session? * Required

Increased relaxation

To feel grounded

Stress reduction

Anxiety reduction

Healing for physical pain

Healing for emotional pain

Enhanced clarity/peace of mind

Balancing/clearing of energy

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