Before your session, please make sure you’re in a quiet, comfortable space where you won’t be interrupted or disturbed. Wearing comfortable clothing is recommended so you can fully relax. It may also be helpful to have some water or any tissues nearby, just in case. For pet sessions, please have your pet present with you. They don’t need to sit still — they can be playing with a toy, sleeping, or chewing on a treat. Whatever helps them feel relaxed and safe is perfectly fine.”

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Full Name *

Phone Number

Email *

Occupation / What do you do for work?

Wellness Check-In How are you feeling today — emotionally, physically, mentally, and spiritually?

Health Background Do you have any diagnosed conditions, illnesses, or diseases?

If yes, Please describe below:

Are you currently seeing a doctor, therapist, or specialist for any condition?

If yes, Please list if comfortable:

Where in your body do you experience pain?

• Neck
• Head
• Shoulders
• Upper Back
• Lower Back
• Arms/Hands
• Hips
• Legs/Knees
• Feet
• Any other

Rate your pain level today (0–10)

Pain Level: ____ / 10

Is the pain constant or does it come and go?

Constant? Comes and goes?

Anything else you’d like me to know about your pain?

— does to

Healing Goals What are your intentions for this Reiki session?

For Pet Reiki Clients (Optional)

Pet’s Name | Pet’s Age & Breed | Behavioral or emotional concerns:

Any medical conditions your pet has:

Is there anything else you’d like me to know before your session?

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