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Client Information Form

Reiki Practitioners do not diagnose conditions, nor do they prescribe substances or perform medical treatment, nor interfere with the treatment of a licensed medical professional. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment or condition I may have.

I also understand the body has the ability to heal itself. Long-term imbalances in the body require multiple sessions to allow the body to reach the level of relaxation necessary to bring the system back into balance.

I understand and believe that self-improvement requires commitment on my part, and that I must be willing to change in a positive way if I am to receive the full benefit of Reiki.

Multi-line address
Birthday
Month
Day
Year
Are you currently taking any medications?
Yes
No
Are you currently under the care of a Physician or Specialist?
Yes
No
Are you currently receiving other alternative treatments?
Yes
No
Do you or have you ever suffered from seizures?
Yes
No
Would you like to receive occasional update from Sakura Wellness?
Yes
No
Are you OK with being touched “appropriately” during the Reiki session or do you prefer not to be touched at all?
Touch is OK
Prefer not to be touched

Inappropriate touch of any kind by the Reiki practitioner or the client is a breach of the Reiki Code of Ethics.

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©2024 by Sakura Wellness

(774) 773- 6979   | support@mysakurawellness.com  | 8 Sagebrush, Plymouth, MA 02360

Hours: Saturday10-5pm (book on-line); Monday - Friday and Sunday (call to make appointment) 

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