Reiki Healing Intake Form

Preparing for Your Healing Journey

Thank you for choosing Reiki healing with The Nurturing Well.

This form will help me understand your needs and goals so I can create a personalized and supportive experience for you.

Please take a moment to answer the following questions.

First name*

Last name*

Your email*

Phone number*

Preferred Method of Contact*

Phone

Type of Session*

In-Person

Distance Reiki

Have you received Reiki before?*

Yes

If yes, please describe your experience?

What are your primary goals for this session?*

Are there any specific areas of your body or energy field where you feel blocked or in need of healing?*

Do you have any current health conditions or concerns I should be aware of?*

Are you taking any medications or undergoing medical treatment?*

Do you have any injuries, surgeries, or areas of physical discomfort?*

Are there any emotional challenges or life circumstances you’d like support with?

Do you have any spiritual practices or beliefs that are important to you?

Do you have any preferences for your session?

Is there anything you’d like me to know to make your session more comfortable?

Reiki is a gentle, non-invasive energy healing practice that supports overall well-being. It is not a substitute for medical treatment, and I recommend consulting a healthcare professional for any medical concerns.*

I understand that Reiki is a complementary therapy and not a replacement for medical care.

I consent to receive Reiki healing from The Nurturing Well.

Reiki Healing Intake Form

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