Reiki Intake Profile for Its A Phase

Reiki Intake Profile for Its A Phase

* Required

Email address *

Your email

Name *

Your answer

Name you prefer to be called *

Your answer

Prefered pronoun (i.e. he/she/they/them) *

Your answer

Contact Phone Number *

Your answer

Emergency Contact Name and Phone Number *

Your answer

Are you currently under the care of a physician? *

Yes

No

If yes, for what reason?

Your answer

How did you hear about us? *

Option 1

Have you had a reiki session before *

Yes

No

If yes, what was the focus of care?

Your answer

Are you allergic to essential oils or perfumes *

Yes

No

If yes, which one(s)?

Your answer

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