Intake Form: Animal Reiki Clients
THANK YOU FOR CHOOSING ALL IS ONE WELLNESS ARTS FOR YOUR ANIMAL COMPANION'S NEEDS. THESE FORMS ARE QUITE COMPREHENSIVE TO ALLOW US TO PROVIDE THE BEST POSSIBLE CARE.

I am a professionally licensed and insured practitioner. I adhere to the highest ethical standards of practice and compliance with national and state laws regarding my profession. Please note that my care is not a substitute for appropriate veterinary care.

ANIMAL REIKI CLIENTS: PLEASE FILL OUT THE FORM BELOW.

(EQUINE PHYSIOTHERAPY CLIENTS: RETURN TO WEBSITE TO FILL OUT THE EQUINE PHYSIOTHERAPY FORM.)
Date *
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Name (First & Last) *
Email Address *
Phone Number *
Animal's Name *
Species (if selecting 'Other', please write in species) *
Sex *
Breed (if a cross, please describe your best guess) *
Year born (approximate, if unknown) *
Was this animal ever abused, neglected, or a rescue? *
How long have you owned or cared for this animal? *
Name of animal's veterinary clinic *
Is animal current on vaccinations/deworming? *
Describe current living situation (e.g. inside only, outdoors only, kenneled, etc.) *
Are there any other animals in the home? *
Describe primary reason for seeking Reiki/bodywork/alternative therapies *
Have you seen a vet for this issue? *
Describe any accidents/illnesses (please also list if there have been any surgeries or major diagnostic work) *
Does your animal have any specific diagnosis FROM A VETERINARIAN, and for how long? (e.g. "kidney disease, diagnosed 2 yrs ago" or "hip dysplasia, confirmed by vet 6 mo ago") *
Describe average amount of play or exercise animal gets in a typical week *
Please describe diet, including brand, amount, and supplements *
Has your animal ever bitten/clawed anyone? *
Describe any habits your animal has that may affect health (e.g. eating rocks/trash; small dogs leaping off furniture; instigating rough play with larger animals) *
Is your animal shy or nervous with new people? *
Does your animal dislike being touched anywhere? (e.g. hates tail touched, nervous around men, etc.) *
Tell me about your animal's personality and their best trait *
What are your hopes for this Reiki session? *
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