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Reiki Consent Form

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Have you had Reiki before? If so, what was your experience?

Are you ok with touch and light stretching to release stagnant energy?

Any areas of concern?

What is your goal if any for this session?

Are you sensitive to essential oils or scents?

Are you pregnant? If so, how far along?

Do you suffer from chronic pain? If so, where?

Do you consent to getting Reiki today?

Signature

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Date

Month

Day

Year

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