Client Intake Form

This form is for clients who are already scheduled and planning to receive a service. Please complete all sections before your appointment. Your information is kept confidential and emailed securely to Amber upon submission.

Client InformationMedical HistoryMedical DisclaimerAcknowledgement
Best method of contact?
Have you had a Reiki or Holistic Session before?
Will you be comfortable lying on your back during the session?
Are you sensitive to touch?
Are you sensitive to sound?
Are you sensitive to smells/fragrances/aromas?
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Reiki, CST and Reflexology is hands on therapy, unless otherwise requested.