Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *Email *Best phone number to reach you *FB/Insta name (optional) *AddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateHave you ever had a Reiki session before? *YesNoWhat areas you would like your treatment to focus? Emotional/Physical/Spiritual or general wellbeing? *I understand that Reiki is a simple, gentle, hands-on and/or remote energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions, nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. I understand that Reiki can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. Signature *Clear SignatureDate: *Parent/Guardian *Clear SignatureDate: *Privacy Notice: No information about any client will be discussed or shared with any third party without written consent of the client or parent/guardian if the client is under 18. By submitting you agree that no information on this site or by any practitioner is not to replace medical advice. Reiki is Complimentary to all healing paths. Information gathered is for the purpose of client communication and is not released or sold to any third party. Thank you for accepting the essence of Reiki.Submit