Reiki Session Intake Form

Name *
Name
Address
Address
Phone *
Phone
Session Type *
Are you new to Reiki? *
Please describe what you would like to accomplish with Reiki Energy Healing?
Please include session date and time preferences and any additional details/requests for your session.
I, the undersigned, understand that the Reiki session given involves a natural hands-on method of energy balancing for the purpose of pain management, stress reduction, and relaxation. I understand very clearly that these treatments are not intended as a substitute for medical or psychological care. I understand that Reiki practitioners do not diagnose conditions, nor do they prescribe medicines, nor interfere with the treatment of a licensed medical professional. It is recommended that I seek a licensed health care professional for any physical or psychological ailment I have. I understand that the practitioner will be placing hands on me during the Reiki session. By typing your name below and selecting the checkbox below, you are signing this agreement electronically. You agree your electronic signature is the equivalent of your manual signature on this Agreement.
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