Reiki Session Request Form Thank you for your interest in scheduling a Reiki session. Please complete this form so I can learn more about you and determine whether Reiki aligns with your wellness goals. I'll contact you within 1–2 business days to discuss scheduling. Contact Information Name* Date of Birth Phone Number* Email Address* Preferred Method of Contact PhoneEmailText Session Preference I am interested in In-Person Reiki SessionDistance (Virtual) Reiki SessionNot Sure What Brings You to Reiki? What would you like support with during your Reiki session? (Examples: stress management, relaxation, emotional balance, feeling grounded, personal growth, overall wellness.) Current Wellness How have you been feeling lately? CalmStressedOverwhelmedFatiguedAnxiousEmotionally DrainedDifficulty SleepingOther If "Other," please describe Health Information Are there any health conditions, recent surgeries, pregnancy, injuries, or mobility concerns that would help me make your Reiki session as comfortable as possible? YesNo If yes, please let me know to ensure your comfort during treatment Goals for Your Session What would you like to experience or gain from your Reiki session? Additional Information Is there anything else you would like me to know before your appointment? Consent Please check each box to acknowledge the following: I understand that Reiki is a complementary wellness practice intended to support relaxation and overall well-being. I understand that Reiki practitioners do not diagnose conditions, prescribe medications, or provide medical or mental health treatment. I understand that Reiki is not a substitute for medical, psychological, or other licensed healthcare services. I understand that I am responsible for my own healthcare decisions and will consult my healthcare provider regarding any medical concerns. I certify that the information provided on this form is accurate to the best of my knowledge. I understand that long-standing imbalances may require multiple sessions to help the body reach the level of relaxation needed to support its natural healing process. Electronic Signature Name* Date*
