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Ascension Journey Reiki in Barrhaven Ottawa Ontario

Reiki Intake Form

Please fill out the following form prior to your appointment

Name

Email

Date of Birth

Phone

Address

Have you had Reiki sessions before? *

No

Yes

Are you comfortable with appropriate light touch, or do you prefer hands above the body? *

Light appropriate touch is fine

No. I prefer not to be touched

Please inform of medical or mental health conditions

What would you like to address/accomplish with your Reiki sessions? Select all that apply * Required

Stress reduction

Relaxation / Meditative Aid

Physical issues

Emotional Trauma(s)

Spiritual Enlightenment/Ascension

If needed, please elaborate in more detail, what you'd like to focus on for Reiki healing

Thanks for submitting!

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