CLIENT CONSULTATION FORM

The information you supply will inform our consultation and is strictly confidential

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

What is bringing you to Reiki/Sound Healing?

Is there a specific focus you would like to explore during the session both individually and jointly?

Do you have any medical conditions or are you receiving any medical treatment?

Are you currently taking any medication?

Are you receiving any other complementary therapies?