Reiki – New Client Intake Form By oceanstatewitch / September 8, 2026 / No Comments HomeForms Reiki – New Client Intake Form Website Step 1 of 4 Name FIRST & LAST * Email * Phone # * Emergency Contact * Who can we thank for this referral? Next GETTING TO KNOW YOU Lets get to know your Reiki history - whether you've had it or this is your first time. Have you ever had reiki?Select an optionYesNo How long has it been since your last reiki session?Select an optionLess than 1 monthGreater than 1 monthLess than 6 monthsMore than 6 months6 months - 1 year1-2 yearsMany years If yes, what did you enjoy most about that session? Back Next REVIEW OF BODY SYSTEMS Below we will review your body systems and if you have noticed any changes within the past few months or since your last session. HEENT * YES NO SEE COMMENT SKIN * YES NO SEE COMMENT ALLERGIES * YES NO SEE COMMENT LUNGS & BREATHING * YES NO SEE COMMENT BONES & JOINTS * YES NO SEE COMMENT HEADACHES / TINGLING * YES NO SEE COMMENT MOOD CHANGES * YES NO SEE COMMENT PAIN * YES NO SEE COMMENT EXPLAINTATIONS * Back Next QUESTIONS FOR THIS REIKI SESSION: Some questions to make this session more comfortable. If this is an "in person" session, are you sensitive to touch?Select an optionThis session is in person - YES, I'm sensitive to touch.This session is in person - NO, I'm not sensitive to touch.This session is a distance session and does not apply. If this session is "in person", are you opposed to light touch?Select an optionThis session is in person - YES, I'm okay with light touch.This session is in person - NO. I do not consent to light touch.This session is a distance session and does not apply. If this session is "in person", are you sensitive to smells?Select an optionThis session is in person - YES, I'm sensitive to smells.This session is in person - NO, I'm not sensitive to smells.This session is a distance session and does not apply. What are your goals for this session? * Back Register
