Reiki Intake Form

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Reiki Intake Form

We need only a few basic details before your Reiki treatment:

Email *

First Name *

Last Name *

Address *

How did you hear about us? *

Word of Mouth

Google search

Social media

Meet up

Voucher

Other:

Check this box if you would like to receive irregular and spontaneous updates from me: *

Yes please

No thanks

Required

Optional additional relevant information:

Please read carefully before signing

I have completed the information above truthfully and to the best of my knowledge. I understand the treatment I will receive is an energy therapy and I understand that it is in no way replacement for doctor/medical care. Information provided to me by the therapist is educational by nature and will be used at my discretion.

By typing my name below, I confirm that I understand and agree to above statement. *

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