In Person Reiki - Nichola Veitch

Name*
First Last
Date
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Address
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Phone Number
Emergency Contact
First Last
Emergency Contact Phone Number
Your Email Address*
Occupation
How did you hear about my services?
Have you had a healing treatment before?
- Yes
- No
Date of last session
Date Format: MM slash DD slash YYYY
What is your goal for your Reiki session?
Do you have any difficulty lying on your back for the entire session?
- Yes
- No
Which tools are you comfortable with me using during your session?
(Check all that apply)
- Incense
- Candles
- Essential Oils
- Crystals
- Music
Do you have any additional comments or questions before your session?
Are there any particular areas you would like me to focus on during our session?
Do you have any special health issues or requirements I need to know about?
(include health restrictions, allergies or other serious health concerns, and if required information on emergency care and your doctor)
Is there anything else you would like me to know?
Name
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