Reiki New Client Form Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone NumberEmail *Have You Ever Had a Reiki Session BeforeYesNoIf Yes, How Many Sessions and When Was Your Last Session?On a scale of 0 to 5, how satisfied, content, or joyful do you feel in each of the main aspects of your life? 0 would indicate you feel no satisfaction while 5 stands for a great degree of contentment. Body/health Selected Value: 0 Business/Career Selected Value: 0 Money and Financial Wellbeing Selected Value: 0 Friendship/Community Selected Value: 0 Family Life Selected Value: 0 Home/Physical Environment Selected Value: 0 Love/Romance/Partnership Selected Value: 0 Fun/Recreation Selected Value: 0 Spirituality/Personal Growth Selected Value: 0 Purpose/Meaning/Contribution Selected Value: 0 Do You Have a Particular Area of Concern?Are You Sensitive to any Essential Oils or Fragrances?Are You Sensitive to TouchSignatureClear SignatureI understand that Reiki is a simply, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki practioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. I understand that Reiki can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.Date *Submit