Distant Reiki Form

Please complete all of this form, this will aid the consulation process and by doing so provides a greater Distant Reiki focus. Please be assured that your privacy is important and is completely 100% confidential.

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Thank you for your response. ✨

Your Name

Contact Email

House Number / House Name

Postcode

Contact Number

Have you had Reiki or any other healing work before?

Describe any health pains or emotional issues you would like particular help with eg. lower backache, toothache, fatigue, anxiety... quite often physical and emotional issues are connected.

Your preferred time and day for Distant Reiki (daily sessions between 9am to 5pm)

Session Preference(required)

Distant Reiki via Phone / Text Distant Reiki via Messenger Distant Reiki via Zoom

Other Information (to include if the booking is for someone else)

I agree and understand that Distant Reiki is complementary therapy and does not a substitute or replace for medical or counselling needs.

An email will be sent to confirm your booking with further information about the session. Your details are completely confidential and will not be shared. Follow this link for more information about Distant Reiki.