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Reiki Consultation Form

Medical History
Have you had Reiki before
Yes
No
Do you prefer hands on or hands off Reiki
Hands On
Hands Off
What brings you to Reiki today?
How would you describe your current energy levels?
Low
Moderate
High

  • I understand that Reiki is a complementary therapy and not a substitute for medical or psychological treatment.

  • The practitioner does not diagnose conditions, prescribe medication, or interfere with the treatment of licensed medical professionals.

  • I take full responsibility for my health and wellbeing during and after the session.

  • All personal information will remain confidential

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