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New Client Intake Form

Please take a moment to fill out the form before your first appointment.

Preferred Method of Contact

Health Information

Please note that Reiki is a complementary therapy and not a substitute for medical treatment. This information helps me provide the best care for you.

Are you currently under the care of a health professional?
Do you have any diagnosed medical conditions or physical limitations?
Are you currently pregnant?
Do you have any chronic pain or discomfort?
Do you have any allergies or sensitivities (e.g.,scents, oils, fabrics)?

Reiki Session Preferences

Have you ever received reiki before?
Do you prefer hands-on Reiki or hands-off (hovering above the body)?

Confidentiality and Consent

All information provided on this form is confidential and will not be shared without your consent.

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Reiki is a complementary modality and not a replacement for medical or psychological treatment.

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By signing below, you acknowledge that you understand the nature of Reiki and consent to receive treatment.

Thanks for submitting!

© 2025 by Lotus Leaf Reiki & Chakra Healing

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