Pets Energy Work - Intake :: The Reiki Room

This form should be filled out prior to our first session as I will be reviewing in prior the start session and it is helpful for me to get acquainted with you prior to seeing you. It's strongly recommend that you log-in prior to starting to fill out the form as this will allow you to view the form from your profile later on. Logging in however is not required.

About your Pet

Pet Name

Pet Birthdate

Americas/New York

Date of First Session

Americas/New York

Emergency Contact Name, Phone Number, and relationship

Prior Energy Healing Work

Has your pet ever had an energy session before? If so, when was it and how often did you meet?

Describe your purpose for the session and your experience

Session Goals

What is your goal for this Healing session? (Check all that apply)

Relaxation

Wellness

Increased Vitality

Stress Reduction

Pain Reduction

Your pet does not have to be in a certain position for the session. The practitioner will work with your pets free will. Please write any comments you feel are necessary:

Stressful Event: Check if a stressful event has happened to your pet recently.

Is there a particular area(s) of the body where you would prefer to focus on with your pet? Is your pet experiencing tension, stiffness, pain, or other discomfort/distress? yes no If yes, please explain:

If yes, please describe it and how you think it has affected your pet’s health and behavior?

Pet History

Does your pet have any allergies or sensitivities? yes no If yes, please explain:

Is your pet currently under medical supervision? yes no If yes, please explain:

Is your pet currently taking any medications? yes no If yes, please list:

Is there anything else about your pet’s health and history that you think would be useful for your Practitioner to know to plan a safe and effective session?

Certifications & Consent

I understand that if I did not pay at time of booking, I must pay at the time of the session. I understand that if I do not pay for the session I will not be able to book another session until it is paid for and the next session must be paid in advance.

I, ____________________________ understand that the healing my pet receives is provided for the basic purpose of pain relief, relaxation and relief of tension and stress. I understand that the healing should not be construed as a substitute for medical ex

Please type your name, this is equivalent to your signature

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Enter today's date and time

Americas/New York

What is your address?

Address 1

Address 2

City

Country

State/Province

Postal Code

What is your Phone Number?

Hours