Energetic Massage Client Intake Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Your healer requires this information for a professional service and assessment. All information is strictly confidential. You may submit a registration for someone else, including children. Just fill out a separate form for each person.

Email *

What To Expect

This energy healing technique finds where you have energy blockages caused by trauma, stress, grief etc. The main goal is to help you live your highest vibration and light by releasing these blockages. The session is done in the evening and recommend you relax or go to sleep. There is no Zoom. I do all the work and after the session I email you what I saw or felt or any recommendations. That's it.

First Name *

Last Name *

Main Reason for Consultation *

Have you had a Reiki Treatment before

Yes

Clear selection

Please indicate child, adult or if you're pregnant. This is important so I know how much energy to apply, children require less.

Child (under 14)

Adult (over 14)ccc

Pregnant

Anything else I should know? Any comments?

Please send karmic exchange of $11/per person via Venmo to @holisticbossbabe or PayPal to holisticbossbabe@gmail.com

Please only write first and last name for each person receiving a healing in the notes of your Venmo nothing else please

Namaste 🙏🏼✨

Consent *

I understand that Reiki and Complementary healing Modality and does not at any point become a medical profession or would not at any pointto claim to be one.

Required

Signature & Date *

Please enter your full name and today's date

Recommendations

Please drink lots of water the next day as energy will be moved. Before your session, write in a journal what you feel, any discomfort, any pain, emotions, write your intentions. The day after your session write about the same and see if you notice any changes. Thank you for selecting me as your Reiki Practitioner. *Yvonne

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms