Reiki/Healing Treatment Plan Follow-Up Form

All information provided is private and confidential.

No information about any client will be discussed or shared with any third party without written consent of the client or parent/guardian if the client is under 18

(* Required)

    In preparation for your next session, could you please provide the following information:
    Full Name*
    Email*

    On the day (or day after) of your last treatment
    Have you experienced any of the following signs:
    Short-term increase in symptomsNeeding to sleep or restHeadacheFeeling emotionalIncreased urinationTemporary 'flu'-like symptoms.
    (Please note that the above are all positive signs that are seen indicative of a body bringing itself back into balance. It is also completely normal not to experience any of the above).
    Have you noticed any changes? Please provide as many details as you possible.*
    Could you notice or and quantify any improvements? Please provide as many details as you possible.*

    Since your INITIAL CONSULTATION
    Have your symptoms improved?
    YesNoThe same
    Have your energy levels increased?
    YesNoThe same
    Has your sleep quality improved?
    YesNoThe same
    Do you have any additional comments or questions before our next session?

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