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Welcome to my reiki practice

Please fill out this form below prior to our reiki session together. I am looking forward to it!

Reiki Offers

please fill out all required fields. Thank you 🌙. Your Info is never shared!

Name & Pronouns

Your legal or preferred name or both

What are your sun, moon, and rising sings:

If you don't know, simply name your astrological sign (this is your sun sign)

Email

Preferred time & day for reiki

Please include your preferred time/day

Have you had energy work done before?

Yes

No

Energy work done previously:

Are you currently receiving any treatment by a medical professional or have you been diagnosed with any physical or mental ailments?

e.g.: I was diagnosed with PCOS and am currently taking ...

Intention setting / Reason for reiki session

Please indicate your goal if you have one for this reiki session. If not, we can set one together prior to beginning the session.

General questions about reiki & comments for me:

BONUS: What is your biggest pain point currently?

e.g.: I feel stuck in my current job/ I have no energy for things...

Were you referred to me?

Yes

No

If yes please indicate name of person / if no, indicate how you found me:

I understand that reiki is not a substitute for a visit to a medical professional and reiki sessions do not include a medical diagnosis or medical advice.

Yes

No

Date

MM

DD

YYYY

Sign by entering your initials & your favorite Emoji

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please fill out all required fields. Thank you 🌙. Your Info is never shared!

I acknowledge I am on Munsee Lenape land, and honor the animals, the earth, and the oririnal peoples to whom i give gratitude and support in words and action.