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Somatic Reiki Intake Form

Please complete this form before your first Somatic Reiki session.


It helps me understand what you’re currently experiencing, what you may need, and how I can best support you. All information you share is kept strictly confidential between client and practitioner, and is used only for general assessment.

 

I recognize that sharing personal details can feel vulnerable. I will receive your words with respect, care, and without judgment.

Have you received Reiki before?
Yes
No
How are you feeling today (Check all that apply.)
Reiki may involve light, gentle touch or may be done completely hands-off. Please check all that apply:
I may incorporate supportive tools such as crystals or gentle sound (tuning forks) during your Reiki session; please let me know if you are open to both, prefer Reiki without additional tools, or are open to my guidance.

Consent & Acknowledgement

I acknowledge:

• Reiki is a gentle, non-invasive energy healing modality that supports relaxation, stress reduction, and overall well-being.

• Reiki is not a substitute for medical or psychological treatment.

• No specific outcomes or results are guaranteed.

• I am responsible for communicating any discomfort, emotional overwhelm, or physical needs during the session.

• I may choose hands-on touch, hands-off Reiki, or decline touch at any time.

• Information I share will remain private and confidential.

• I am participating voluntarily and may stop the session at any time.


I have read and consent to receive Reiki from Amy at Light, Love & Reiki.

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Date
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How did you hear about Amy / Light, Love & Reiki?
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Social media (Instagram, Facebook, etc.)
Namaspa Yoga & Massage
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