Reiki Request Form

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Reiki Request Form

Please use this form to schedule a reiki session for yourself or your pet.

Email *

Name *

Phone Number *

Address *

Who is the reiki session for? *

Myself

One of my family members

My pet

Name of whom the reiki session for? *

How did you hear about us? *

I am requesting the following reiki session for pet *

in-home 60 minutes

in-home 90 minutes

distance reiki 60 minutes (with detailed report-of-findings)

distance reiki 60 minutes (no report needed)

I don't need a session for my pet

Other:

I am requesting the following reiki session for myself *

distance reiki 60 minutes (with full detailed report-of-findings)

distance reiki 60 minutes (no report needed)

distance reiki 90 minutes (with full detailed report-of-findings)

distance reiki 90 minutes (no report needed)

I don't need a session for myself

Other:

I understand that the Reiki session given is for the purpose of stress reduction and relaxation to promote healing. I understand very clearly that a Reiki session is not a substitute for medical diagnosis and treatment. Reiki practitioners do not diagnose conditions, nor do they prescribe, perform medical treatments, nor interfere with the treatment of a licensed medical professional.

It is recommended that if this session is for my pet, I take my pet to a licensed veterinarian or licensed health-care professional for any ailment my pet has.

If this session is for myself or another family member, it is recommended for myself or family member to seek a doctor or a licensed health-care professional for any ailment we may have.

I understand

Payment is due upon booking to secure date and time.

I understand

I would like to pay by the following method

Venmo

Credit Card (credit card payments have a 3.5% fee added to the total amount)

Check (to be received and clear the bank before scheduled session)

Gift Certificate

Other:

I understand that once I schedule my appointment and pay for my reiki session, the money paid is non-refundable and non-transferable.

I understand

I understand that if I do not cancel my appointment within 48 hours of the appointment, there is a 25% cancelation fee.

I understand

Full payment is required for no-show or missed appointments.

I understand

Appointment can be rescheduled without any loss of money if rescheduled before 48 hours of appointment time.

I understand

Please type your name below in place of your signature

Please enter today's date below

A copy of your responses will be emailed to the address you provided.

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