New Client Intake Form

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Please fill out this form prior to our first session and click submit.

In Office Sessions: Hands In Harmony Franklin Square NY
* Reiki * Raindrop Therapy Massage * Infrared Sauna * Sound Bath Meditations *

Virtual Sessions: Via Zoom
* Distance Reiki * Sound Bath Meditations *

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)

Yes I Am Allergic To Tree Nuts.

Yes I Am taking Blood Thinner Medication.

Yes I am Sensitive to Perfumes and Fragrances.

Yes I am Sensitive to Touch.

No I do not have any Allergies

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. *

Reiki - YES

Reiki - NO

Raindrop Therapy Massage - YES

Raindrop Therapy Massage - NO

Sound Bath Meditation - YES

Sound Bath Meditation - NO

Required

Please Read the Following and Check To Agree *

Please arrive at office location or log into zoom session 5 minutes prior to start time.

Please wear comfortable clothes for office sessions and leave shoes in the front room.

Please use headphones for zoom sessions to experience the healing musical overtones.

Please shut off your phone ringer and set your other devices to do not disturb.

I understand my information will not be discussed or shared with any third party.

I understand these sessions are a safe, confidential, sacred container and totally private.

I understand these services promote relaxation and that will support my body's healing.

I understand my body has the ability to heal itself when it is totally relaxed during sessions.

I understand this does not interfere with treatments from a licensed medical professional.

Any intuitive medical, spiritual, emotional messages do not substitute a physician's advice.

I understand for Reiki and Sound Meditations to be effective I must be open to receive.

Required

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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