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Reiki Consultation Form
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Email
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Your email
Full Name
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Your answer
Today’s date
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Address
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Your answer
Contact Number
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Your answer
Date of Birth
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YYYY
Occupation
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Your answer
Emergency Contact (Name and phone number)
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Your answer
What are your reasons for receiving a reiki treatment?
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Your answer
Do you have any medical/health conditions?
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Your answer
Are you currently taking any medication? If yes, please state below.
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Your answer
How many hours sleep to you usually get each night?
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4-5
5-6
6-7
8+
What are your energy levels like?
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High
How stressed do you feel at the moment?
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Extremely stressed
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