Reiki Client Consent Form
Please complete this form prior to your appointment. Please let me know if you have any questions. Thank you!

Practitioner: Candace Powers
Phone: 7576728752
Sign in to Google to save your progress. Learn more
Name (Last, First) *
Address: *
E-mail: *
Emergency Contact: *
Are you under a physician's care? *
If so, what is your physician's name?
Medications or Supplements *
(Name, Dosage, Frequency)
Describe your sleep cycle. *
Hours per day? Consistent or inconsistent?
Are you sensitive to touch? *
Are you sensitive to fragrances? *
Essential oils, incense smoke, etc.
Do you find any of these sounds to be relaxing?
Would you like to work on anything specific for you session?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy