Reiki Session Form
Please fill out this form prior to your Reiki session
Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Address with postcode *
Email *
Contact mobile number *
Reason for the Reiki session *
Medical information - tick box that applies
Medical information, please use this space for any ticked boxes
Lifestyle information
Lifestyle information - please use this space for information you feel important
Reiki Session *
Coronavirus questions *
Required
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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