Human Reiki Intake Form

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Question 1 of 5

What is your area of concern of wellness concern? Physical? Emotional? Spiritual?

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Question 2 of 5

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

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Question 3 of 5

Current medications and dosage.

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Question 4 of 5

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

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Question 5 of 5

How did you hear about my services?

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