Client Intake Form

Full Name *

What do you hope to gain from this experience today? *

Email Address *

Phone Number *

Is it ok for me to follow up about your appointment?
Yes No

For some sessions, Reiki will be used to support the client. Reiki involves a series of hand placements on or just above a person's fully clothed body. The practitioner channels energy through their hands into the recipient's body. You must be ok with some physical contact.
I agree

Would you like to receive early access to future events, special sessions, and offers?
Yes, email me
No thanks

Media & Photography Consent
Occasionally, moments from our sessions may be captured in photos or short videos to share the atmosphere of these gatherings, always respectfully, never intrusively. Please indicate your comfort level below:
Yes, I consent to being included in photos/videos that may be used for social media or promotional purposes.
Yes, but no close ups
No, I prefer not to appear in any media

Waiver & Acknowledgement
By attending, I acknowledge that I am participating voluntarily and take full responsibility for my physical well-being.
I understand this is a private residence and agree to be respectful of the space and other guests. I agree. *

Submit