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Free Reiki Offering - Client Form
Please fill this form out if you're interested in being eligible for a free Reiki session as part of my community offerings. I will choose (2) recipients monthly and contact them privately for scheduling.
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Name
*
Your answer
Email
*
Your answer
Your Location
*
Your answer
Have you ever had a Reiki session before?
*
Yes
No
Why are you interested in a Reiki session?
*
Your answer
Do you have a specific area of concern?
Your answer
Do you have any injuries?
*
Yes
No
Do you have a primary care doctor?
Yes
No
Clear selection
Do you attend therapy sessions?
Yes
No
Interested but haven't had the opportunity
Not interested
Clear selection
Are you sensitive to perfumes or fragrances? (i.e sage, palo santo, oils, etc.)
*
Yes
No
Other:
Social Media/Website
Your answer
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