Reiki Intake Profile for Its A Phase
Email address *
Name *
Name you prefer to be called *
Prefered pronoun (i.e. he/she/they/them) *
Contact Phone Number *
Emergency Contact Name and Phone Number *
Are you currently under the care of a physician? *
If yes, for what reason?
How did you hear about us? *
Have you had a reiki session before *
If yes, what was the focus of care?
Are you allergic to essential oils or perfumes *
If yes, which one(s)?
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