Name
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First Name
Last Name
Email
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Phone
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(###)
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What is the primary reason for your inquiry?
Session Location
New York City
Hudson Valley
Virtual
Other
I give permission to have a private session administered by touch - either virtually or in-person.
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The session, and Reiki System of Natural Healing session is classified as spiritual healing. The session does NOT take the place of medical treatments or advice. I understand that there are no claims or guarantees of healing or curing disease.
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I agree to Covid-19 safety protocol, including hand-washing, sanitation, mask usage, and contact tracing if applicable. Should I become ill or experience any symptoms of Covid-19, I will alert the practitioner immediately.
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I will show proof of Covid-19 vaccination prior to the start of the session.
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If this is our first session, please provide the name and contact information for one reference.
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To verify you, please provide a link that can confirm your identity (Linkedin, Instagram, Facebook, etc.)
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What, if any, health concerns are you currently receiving treatment and/or medication for?
What areas of your body do you tend to hold tension or stress?
Do you have any sustained injuries? Did they require medical attention or surgery?
Do you have any chronic conditions?
Are you currently receiving any other forms of treatment from holistic or health care professionals? (i.e. acupuncture, herbs, homeopathy, prescription drugs, supplements, psychotherapy, nutrition program, etc.)
Any additional notes that would be helpful for the practitioner?
Please check any of the following that you might be interested in making a part of your session. Feel free to ask any questions about these techniques and their application.
Other requests....