Reiki Request

Reiki Session Request

I'd be honored to hold space for you. Please complete the form below, and I'll be in touch to confirm your reiki session.

First name

Last name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Email

Phone

Birthday

Month

Day

Year

Time of Birth (if known)

Birthplace

Include city and state or geographic region and country

Do you have allergies or any sensitivities to scents (e.g., essential oils, incense, etc.)?

Please specify any preferences or dislikes.

Medications

Blood thinners (Warfarin, heparin, aspirin, clopidogrel, rivaroxaban, apixaban)

Sedatives

High-risk meds or preference to avoid essential oils

None of these

Please inform us if you take these drugs to ensure we refrain from using any essential oils that may interact with your medication.

Do you have any metal or medical devices in your body?

No

Yes

This lets us know if sound healing may be considered or should be avoided.

Anything else you'd like us to know?

Select a Saturday or Sunday

Provide an alternate Saturday or Sunday

What time between 9 am and 6 pm is best for you?

Time

HoursMinutes