Reiki Client Intake & Consent Form

Brilliance Healing Studio

Welcome. Thank you for choosing Reiki as part of your healing journey. This form helps me understand your current needs and intentions so I can create the most supportive experience possible for you.

First name

Last name

Date of birth

Month

Day

Year

Phone number

Email address

Emergency contact name

Emergency contact phone number

How did you hear about Brilliance Healing Studio?

Google Search

Social Media

Friend or Family Referral

Existing Client Referral

Local Event or Fair

Website

Other

Reiki Client Intake & Consent Form