Holy Fire® Reiki Intake Form

Reiki is a healing modality that integrates the universal life force energy in order to balance the subtle energies within our body. It heals and can balance our physical, mental, emotional, and spiritual being. 

Reiki is not a replacement for traditional medical treatment.

During a remote Reiki session, your Reiki practitioner position their hands in a series of hand positions to deliver Reiki energy. You might feel a floating sensation, emotional release, increased relaxation, enhanced sense of balance, centeredness, and calm.

The effects of Reiki are progressive in which regular Reiki treatments can bring forth significant benefits. Regular sessions support well-being in many ways.

If you experience any pain or discomfort during this session, immediately inform the practitioner.

Are you currently under the care of a physician?
Is there any injuries, surgeries, or recent health conditions that you feel the need to share?
What are your goals for receiving Reiki?
Have you ever received a Reiki Sesson before?

I understand that Reiki is a simple, gentle, Hands-On/Distance  energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribed substance, nor interfere with the treatment of a licensed medical professional. 

I understand that Reiki does not take the place of Medical Care. It is recommended that I see a licensed physician or license Healthcare professional for any physical or psychological elements I may have. I understand that Reiki can complement any medical or psychological care I may be receiving.

I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long-term and balance in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.

Privacy notice: No information about any client will be discussed or shared with any third party without written consent of the clients or parents/guardian if the client is under 18.

Please sign if you acknowledge the given information and give your consent to receive the treatment.

Thanks for submitting!