reiki client information form Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country How did you hear about us? Have you ever had a Reiki Session before? Yes No If yes, when was your last session? Do you have a particular area of concern? Number of previous sessions I understand that Reiki is a simple, gentle hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions no do they prescribe or perform medical treatment, prescribe substances, no interfere with the treatment of a licenses 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 aliment 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. I agree Thank you! Kaitlyn will reach out to you soon with next steps / scheduling options.
