New Client Intake Form
Please fill out this form prior to our first session and click submit.

In Office Sessions: Hands In Harmony Franklin Square NY
* Reiki * Raindrop Essential Oil Therapy * Sound Bath Meditations *

Virtual Sessions: Via Zoom
* Distance Reiki * Sound Bath Meditations *
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Email *
First and Last Name *
Cell Phone *
Full Address (Number, Street, Town, Zip, Country) *
Emergency Contact Name and Phone *
Check what applies to you. (for in person office sessions only / skip if you are a zoom online client)
Do you have a particular area of concern? ( Physical or Emotional?) *
How did you hear about me? *
Have you ever had the following services before? Check what applies to you. *
Please Read the Following and Check To Agree *
I look forward to your first session. This is an optional space to share anything you feel need to express prior to our first time meeting. You will receive a confirmation email and a reminder the day before your appointment. Love, Light and Blessings!
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