Reiki Intake Form
Please fill this form out if you have purchased an In-Person Reiki Session or Distance Reiki Session! This form is for new clients only! If you have seen me before and this is NOT your first session please fill out my other form
Name *
Your answer
Date of Session *
Your answer
Time of Session *
Time
:
What is your Time Zone? (for distant sessions only) *
Your answer
Age
Your answer
I am 18 years or older *
Phone Number
Your answer
Email *
Your answer
How did you hear about Seeking Soulace with Emily LLC *
Required
Have you ever had a Reiki session before? *
Is this Reiki Session a gift for Someone Else? *
Required
What Distant Reiki Session are you choosing? *
Required
What In-Person Reiki Session are you choosing? *
Required
I would like to add on ________to my sessions..... *
Required
What do you hope to accomplish with this Reiki session? *
Required
Are you pregnant?
Check if you have any of these conditions *
Required
Are you sensitive or uncomfortable with any touch or pressure in any area? If so, please explain. *
Your answer
Are you sensitive to any specific scents? I use essential oils, sage, incense. *
Your answer
Please specify any other conditions, physical, mental, emotional or otherwise which you feel may be important: *
Your answer
Cultural influences or beliefs that would allow me to serve you in the best way I can *
Your answer
Preferred pronouns *
Your answer
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