Reiki Session Form
Please fill out this form prior to your Reiki session
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Date of Birth
Address with postcode
Contact mobile number
Reason for the Reiki session
Have you had a Reiki session before?
Medical information - tick box that applies
Any serious illnesses diagnosed - past or present
Accidents / Operations
Medication (prescribed and non prescribed)
Stress related illness
Other complimentary therapies currently being received
Medical information, please use this space for any ticked boxes
Recreational drugs consumed prior to treatment or on the day of treatment
Alcohol consumed on the day of treatment
Good sleep pattern
Not good sleep pattern
Adequate water intake
Lifestyle information - please use this space for information you feel important
1 hours session
Block booking - buy 2 and 1 FREE
I have not got any symptoms within the last 14 days
I am following the current government guidelines with face mask and social distance
Where did you hear about Learn Reiki and Connect?
Word of mouth / recommendation
Please sign your FULL NAME and confirm that you have provided accurate information and acknowledge the requirements for this service. I understand Reiki is not a substitute for medical or psychological diagnosis and treatment.
Thank you for completing this form - please submit prior to your Reiki session
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