Reiki Energy Healing Session Intake

Reiki Energy Healing Session Intake — Form Fields

This healthcare template includes 13 fields. Intake form for new clients seeking Reiki energy healing sessions. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email (email, required)
• Phone Number (text, required)
• Date of Birth (text, required)
• First Reiki Experience (multiple choice, required) — options: Yes, No
• Primary Reason for Seeking Reiki (dropdown selection, required) — options: Stress Relief, Pain Management, Emotional Healing, Spiritual Growth, Anxiety/Depression, Sleep Issues, Post-Surgery Recovery, General Wellness
• Current Physical Concerns (checkboxes, optional) — options: Chronic Pain, Fatigue, Headaches, Digestive Issues, Autoimmune Condition, Cancer Treatment Support, Pregnancy, None
• Energy Level Currently (dropdown selection, required) — options: Very Low, Low, Average, High
• Comfortable with Light Touch (multiple choice, required) — options: Yes, Prefer Hands-Off (Hovering), Unsure
• Session Length Preference (dropdown selection, required) — options: 30 Minutes, 45 Minutes, 60 Minutes, 90 Minutes
• Current Medications or Treatments (text, optional)
• Intentions or Goals for This Session (long text, optional)
• Anything Else the Practitioner Should Know (long text, optional)