Location of appointment. Full street address or closest town or city. *
Your answer
What is your preferred method of contact? *
Required
Contact Number
Your answer
E-mail
Your answer
Have you ever experienced a Reiki session before?
Clear selection
What is your primary reason for the visit?
If you would rather not discuss this in detail, feel free to leave this section blank.
Your answer
Request for Appointment
Please specify the day of week that works best for you
Time of Day - 1st Preference
I will do my best to accommodate your request, but please understand that may not always be possible.
Time
:
AM
PM
Time of Day - 2nd Preference
Time
:
AM
PM
Are you sensitive to touch? *
Reiki can be delivered without having any physical contact at all. Let me know if you would prefer a hands-off session.
Are you sensitive to perfumes or fragrances? *
The practitioner uses different essential oils such as Lavender, Sandalwood, etc. If you are sensitive, please let me know so I avoid using them during your session.
Do you have any questions or concerns you would like to address before the session?
Your answer
By placing a check mark in the boxes you are acknowledging you understand the information in its entirety. *
Required
CONFIDENTIALITY *
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 years of age.