Intake Form - Initial

Today's Date *
Today's Date
Name *
Name
Phone *
Phone
Address *
Address
Please include full name & phone number.
Please list the number of previous sessions. :)
Disclosure *
I understand that Reiki is a simple, gentle, hands-on/slightly above body energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. I understand that Reiki can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.

Privacy Notice

No information about any client will be discussed or shared with any third party without written consent of the client or parent/guardian if the client is under 18. Your information will be used to communicate with you and will not be given away or sold.