In take Form (New clients only) | reiki-by-sharon-1

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m: 07891 754710

Mind, Body, Soul Connection

e:sharrisreiki@gmail.com

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In Take Form

Only to be filled out once an appointment has been made.

Please take the time to fill out the information below.
Please read the Terms and conditions prior to filling out the form.

Terms and conditions ( opens new window )

Full Name

Email

Phone: mobile/landline

Date of birth

Address

Have you had Reiki before?

Are you currently taking any medication/ dosage? Please provide details

Is there any medical history I need to be aware of? i.e epilepsy etc

Details of any other treatments/therapies being received

Are you happy for light touch throughout the session ?. There are some areas I place my hands, for example, feet, knees and shoulders and on some of the chakra points.

Do you have any difficulty lying on your back for the entire session

Why would you like to receive Reiki?

Stress relief

Anxiety relief

Pain relief

Relaxation

Healing old wounds or Trauma

Healing from past/current relationship/s

Spiritual growth

Healing from a bereavement

Other ( use box below to give details)

Is there anything else you would like to add to be included in your session ?

How did you hear about me?

Important Information

Reiki is not a substitute for medical treatment. If you have any symptoms of illness you should see your doctor.
Reiki is safe and will complement any form of complementary or medical treatment.

A Reiki Practitioner should not diagnose or recommend any form of treatment, other than suggesting you consult with your doctor if appropriate.

You should not make any changes to any medication prescribed or other therapies you are currently undertaking without discussing with your doctor. If you are diabetic or hypertensive (high blood pressure).

It is advisable to monitor levels and readings with your doctor. Reiki may bring things more into balance and this may require a change in your medication regime.

I Agree to the Terms and ConditionsView Terms and Conditions

All information is held in strict confidence

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