top of page
Client Intake Form

(May print and bring to appointment)

Would you lik to be added to the mailing list?
General Information
Are you currently under the care of a physician?

In the presence of a serious health challenge, Reiki practitioners often recommend four sessions over four days. These need not be given by the same practitioner.

Have you ever had a session before?
What do you hope to accomplish ?
Are you sensitive to fragrances or perfumes?

Thank you, we received your form!

Client Intake Form Legal Verbiage

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. 

What you are agreeing to: 
I understand that Reiki is a simple, gentle, hands-OFF energy technique that is used for stress reduction and relaxation. I understand 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 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. 

Client/Practitioner Expectations

The first session begins with a brief interview of clients intake form. You are asked a series of questions so that I may plan the most beneficial session/series of sessions for your needs. Please keep in mind that privacy and confidentiality are maintained at all times. I subscribe to the IARP Code of Ethics as posted in my treatment room. A Reiki session is performed on a massage table and you, the client, are always fully clothed. 
A Reiki session may start with the client lying face up resting comfortably. I will complete the standard Reiki hand positions. If you indicate in the interview or at the beginning of the session that you wish for me to pay attention to a particular injury or issue, I will also concentrate on that area during the session. For a regular stress-reduction session, the head and torso are worked on first, followed by the back and sometimes the feet. Clients can ask for different parts of the body to be worked on, or not worked on, and are encouraged to discuss this with me at the beginning of the session. 

Practice and Center Policy Statement:

During the session, clients are encouraged to relax and inform me if anything makes them uncomfortable, either physically or psychologically. Please feel free to talk with me regarding feedback during the session. I often will talk with you before or after, usually not during as I want you to relax fully during the session. If something feels uncomfortable during the session however, please speak up immediately; I want to know as soon as possible. 

About Christal (Owner): 

I have been practicing Reiki since 2019 and teaching Reiki since 2020. I trained in Reiki with a Master from New York and I am a Registered Reiki Master Practitioner and Teacher (RMT) with the International Association of Reiki Professionals. I also practice Intuitive Guidance and I am a Licensed Medical professional. I specialize in working with people of all ages who wish to utilize Reiki for general wellness and stress reduction as well as for specific tension or pain problems. Looking forward to your session. 

Your content has been submitted

Anchor 1
bottom of page