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Do you prefer an online distance or in-person meetup for your reiki session?
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In Person
Online
First name
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Last name
*
Email
*
Phone
*
Birthday
*
Month
Day
Year
Client's Address ( In Person Session )
*
Are you taking any forms of medication?
*
Yes
No
Please indicate any health challenges that apply to you?
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Anxiety
Depression
Exhaustion
Stress
Other
What is your main purpose for your reiki session?
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Emotional Clarity
Mental Clarity
Physical Clarity
Spiritual Clarity
Are you open to wearing comfortable clothing or none for your reiki session? ( In Person Session Only )
Yes
No
Are you comfortable to experience physical touch during your reiki session? (In Person Session Only )
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Yes
No
Which chakras do you want me to focus on for your reiki session?
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Earth Star Chakras
Root Chakras
Sacral Chakras
Solar Plexus Chakras
Heart Chakras
Throat Chakras
Third Eye Chakras
Crown Chakras
Soul Star Chakras
What preferred time are you available for your session?
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Month
Day
Year
Time
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Feel free to leave any more comments or concerns you have about your session.
*
I am of legal age, would like to participate in this reiki session that is being offered. I fully understand that a reiki session is a calm and relaxing session and that this session is not intended to cause physical injury.
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I agree to declare any health issues, or conditions I may have before signing up for this session. If I might be uncomfortable, any suggested modifications and questions can be discussed with me directly in a respectful manner before the session starts.
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If there are any concerns or emergencies, I can cancel and refund this session to you at any time if there's an emergency, and understand that I have my own emotional, mental, and physical limitations.
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I fully recognize these terms above and any experiences sustained from this session will be my responsibility. Therefore I release any liabilities from the practitioner. I have read and fully understand the terms of the agreement/waiver.
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