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Animal Reiki Intake Form

Prior to your session please make sure your environment is quiet and your animal(s) have access to where you will be sitting comfortably & quietly. This will allow her/him to come closer to you if they choose to. Upon your animal saying "yes" to receiving the healing space feel free to observe them in the healing space. Several signs of them saying yes to Reiki, is yawning, getting in a comfortable spot - usually their fav spot, drinking or eating then settling down, and or running around and then settling down.

** PLEASE MAKE SURE OF THE FOLLOWING****
1. Prior to the session, your animal has exercised (dogs especially) and done their business.
2. Your area is quiet with no interruptions.
3. Have water by your side.
4. After the session give yourself time to move slowly, so don't schedule any appointment within 30 minutes of your session.
5. Be in a calm, loving state of mind and enjoy with no expectations other than a wonderful and relaxing time for yourself and your animal!

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Question 1 of 15

Animals Name

Breed & Age

 

Question 2 of 15

Veterinarian & Date of Last Visit

Question 3 of 15

Where does the animal live?  (house, barn, outside etc.)

Will your animal be with you during the Reiki session? If No, please tell me where they will be?

Question 4 of 15

Please describe your concerns and how long have these issues been present?

Question 5 of 15

Is the animal currently receiving medical treatment, or taking medications for known medical health conditions? Please provide as much details including onset dates: 

Question 6 of 15

Is there a special diet? 

Question 7 of 15

Does he/she get exercise on a daily basis? If YES - please describe. If NO - please provide details of the limitations

Question 8 of 15

Has she or he ever had Reiki before?  

Question 9 of 15

Please upload a picture of your animal

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Question 10 of 15

HUMAN REIKI FORM
What is your area of concern of wellness concern? Physical? Emotional? Spiritual? (Not your animal's!) 

 

Question 11 of 15

Have you ever experienced Reiki before? If so, when was your last session?

Question 12 of 15

Your current medications and dosage.

Question 13 of 15

Are you currently under the care of a physician? If so, what is their name.

Question 14 of 15

How did you hear about my services?

Question 15 of 15

Do I have permission to share for educational purposes? Only a picture and first name of pet is shared. 

A

Yes

B

No

Confirm and Submit