Back to Healing Reiki
 

 

 

 

 

 

 

 

 

 


 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


I Care Petcare
All Rights Reserved

  

                                    Healing Reiki
                                            Reservation Form
 
 
My full name  Email address
Phone numbers Street address, city, zip code


I am familiar with Reiki and/or have previously had a Reiki session Yes No
I request Reiki  for the following session length  60 min 30 min
I would like the following two (2) intensified therapies included with my 60-min Reiki session
                           Chakra Gem Color Sound Aroma Angel Ancient
Separate from my Reiki session, I want a 30-min session focused only the following one (1) therapy
                            Chakra Gem Color Sound Aroma Angel Ancient
What I hope to gain from this Reiki session (please be detailed)
My existing physical (medical) condition is (please be detailed)
My current pain level is LowMedium High 
My existing emotional/mental/spiritual state is (please be detailed)
My current stress level is  LowMedium High 


I prefer to have my session at My home3468 N 77 St 6169B Industrial Ct., Greendale
Specify all dates and times you are available in the next 7 days for an appointment:   


Anything else that would be helpful for Healing Reiki to know


I will be using the one-time "15-minutes free with the purchase of 30 minutes" coupon Yes No


 Your typed name serves as your signature that you understand the statement below.

 I understand that I am responsible for and must take an active role my own healing and that long-term
imbalances may require multiple Reiki sessions. I give permission to "lay hands" and understand that body
privacy is respected. I understand that you, as the Reiki facilitator, only aid in the process by serving as a channel
for the Reiki energy and bear no personal responsibility for my outcome. I understand that the Reiki facilitator
does not diagnose conditions, prescribe substances, perform medical treatment, nor interfere with the treatment
of a licensed medical professional and does recommend seeing a licensed medical professional for physical or
psychological ailments. The facilitator may make suggestions but I must determine if those suggestions are
right for me.


Typed Signature    Date 


Look for an email from sjones1@icarepetcare.com with 24 hours regarding availability.


        completed form to Healing Reiki        to clear form WITHOUT submitting it