REIKI CLIENT FORM

   

REIKI CLIENT FORM

Full Name

Phone

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Have you ever had a Reiki session before?

If yes, when was your last session?

Number of previous sessions in the last 12 months?

Do you have a particular area of concern? (Physically)

Do you have a particular area to address? (Mentally/Emotionally)

How did you hear about YIB or Alexa?

I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation, with other additional physical benefits. I understand that Reiki practitioners do not diagnose conditions, nor do they prescribe or perform medical treatment, prescribe prescription medications, 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.

Yes

Signature

Date

MM

DD

YYYY