Reiki and Reflexology Combi Consultation

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Have you received Reiki and/or Reflexology before?

Reiki

Reflexology

Both

Neither

If yes, when was your last session?

Are you currently receiving medical care or taking medication?

Yes

No

If yes, please specify:

If 'other', please specify:

How would you describe your current energy levels?

Low

Moderate

High

How do you typically manage stress?

Sleep quality:

Poor

Fair

Good

Excellent

Consent & Understanding

I understand that Reiki and Reflexology are complementary therapies that support natural healing and wellbeing.
They do not diagnose or replace medical or psychological treatment.
The practitioner does not prescribe medication or interfere with the treatment of medical professionals.
I take full responsibility for my health and wellbeing during and after the session.
All information shared is treated with complete confidentiality.This is a checkbox.

Signature

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Treatment

30mins Reiki and Reflexology combi£32

60mins Reiki and Reflexology combi£45