New client form

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New client form

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Full Name: *

Email address: *

Contact telephone number: *

Emergency contacts name: *

Emergency contacts telephone number: *

What is your experience with Reiki? *

Please provide a brief medical history and state any medical conditions (physical or psychological) and include any treatment or medications you may be taking: *

Reiki involves light, non invasive, respectful, hands on touch. Are you ok with light touch of this manner? *

YES

What is drawing you towards having a session? *

Please rate the following for yourself from 1-5. 1 being the lowest, 5 being the highest. *

Your current stress levels

Your general level of health

Your ability to feel at ease in yourself

Please state anything else that I may need to be aware of or that you would like to share.

By ticking this I agree that the information I have provided is true to the best of my knowledge. I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki does not take the place of medical care but that it can be used to compliment a person's healing and recovery alongside professional care, or on its own for stress reduction and relaxation if professional medical care is not needed. It is recommended that I see a licensed physician or health care professional for any physical or psychological ailment that I may be experiencing. By ticking this I commit to taking responsibility for myself and seeking professional medical care if I need to. I will also act in a respectful and kind way towards myself and the Reiki master. I am aware that if I need to reschedule or cancel a session, 24h courtesy notice is needed. If a session is rescheduled or cancelled within 24h prior to the session taking place no refunds will be given. Please note that due to a busy schedule, sessions must start and finish on time, if you are late, the session will still finish at the agreed upon time. Please arrive no more than 10 minutes before your session is due to take place as I may be with another client. Thanks for your understanding. *

Please tick this box if you agree.

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