Client forms · F01

Reiki intake form

Prepare an adult client session with contact details, practical preferences, and clear next steps. This short form avoids a blanket request for medical history. Use the separate consent and preferences worksheet to explain the service and record choices.

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F01 · version 1.0.0

Free download. No email required. The DOCX is the structured, editable version for screen readers; the PDFs are print and fill-in copies and are not tagged. Resource license.

First page of the printable PDF · blank file

Who this is for

Independent practitioners preparing an adult, nonclinical session who need contact details and practical preferences before the appointment, without asking for a general medical history.

What the file contains

Client name: Name you use for your appointment; required; text 100.
Contact method: Preferred contact method: email or phone; choose one.
Contact value: Email address or phone number for appointment administration; required; text 120.
Appointment date: Appointment date, if known; optional date.
Adult confirmation: I confirm that I am 18 or older; unchecked checkbox. If not checked, practitioner must resolve eligibility before service.
Session intention: What would you like from this session? Optional, 300 characters. Prompt: Please avoid detailed medical information.
Access preferences: What practical access or comfort arrangements would help? Optional, 300 characters. Invite private discussion if preferred.
Prior experience: Have you attended this type of session before? Yes / No / Prefer not to say; optional.
Discussion request: I would like to discuss the session before deciding; optional checkbox.
Acknowledgment: I have received the practice contact details and know how to ask questions; name/date fields.

How to customize it

Replace the practice contact and return method. Retain only the contact information needed for scheduling. Do not add compulsory medical questions without a documented purpose and appropriate review. A signature on this intake is not a liability waiver or a substitute for an informed discussion.

Scope and limitations

For adult, nonclinical sessions. The form deliberately avoids a blanket request for medical history and is not a liability waiver.

Return completed forms only through the channel your practice designates, never to HolisticHealer.net.

Copy included in the file

Before your appointment, we will explain the service, ask about your preferences, and answer questions. You can decline any question that is not needed for booking. Please do not put diagnoses, medication lists, payment-card details, or emergency information in this general form. If a separate regulated service requires information, the practitioner will explain that process.