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Do you prefer an online or in-person meetup for your Reiki session?
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In Person
Online
First name
*
Last name
*
Email
*
Phone
*
Birthday
*
Month
Day
Year
Client's Address ( In Person Session )
Are you taking any forms of medication?
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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
Energetic Clarity
Mental Clarity
Physical Clarity
Sexual Clarity
Spiritual Clarity
Are you comfortable and open to wearing comfortable clothing for your Reiki session? ( In Person Session Only )
Yes
No
Are you comfortable and open to experiencing physical touch during your Reiki session? (In Person Session Only )
Yes
No
Are you open to listening to relaxing music during your Reiki session?
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Yes
No
Which chakras do you want 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
:
Hours
Minutes
AM
Feel free to leave any more comments or concerns you have about your session.
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By signing this document, I acknowledge and understand that this coach is not a licensed medical professional and this session is for educational purposes only. I hereby waive and release the business, and the owner from any liabilities.
*
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Payment
$88
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