Reiki Client Intake Form Name * First Name Last Name Phone (###) ### #### Email * Address Emergency Contact Who referred you to me? Current Medications Are you currently receiving medical treatment from a doctor? Yes No If so, Doctor's name Have you previously experienced a Reiki session? Yes No If yes, when was the last session? Do you have any specific areas of concern? Are you allergic or sensitive to fragrances or perfumes? Are you uncomfortable with physical touch or physical contact? I am aware that Reiki is a gentle, non-invasive form of energy healing that promotes relaxation and stress reduction. I am aware that Reiki practitioner, Anita Baran Sykes, does not diagnose medical conditions or interfere with the treatment prescribed by licensed healthcare professionals. It is important to note that Reiki should not be used as a replacement for medical care and it is recommended that individuals seek the guidance of a licensed physician or healthcare professional for any physical or psychological issues. Reiki can, however, enhance and complement any medical or psychological treatment you may be receiving. The body has the inherent ability to heal itself, and complete relaxation can often facilitate this process. It may be necessary to have multiple Reiki sessions to address chronic imbalances and achieve the relaxation required for self-healing to occur. * I agree Thank you!
