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
Email: candace.p.crafts@gmail.com
Website: www.starshines.art.com
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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?
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