Reiki Intake Form Template
A free reiki intake and consent form for reiki practitioners and energy healers. Clients share intentions, health notes and touch preferences, then sign.
Customize the pages and design to fit your needs.
About this template
A reiki client intake form that covers contact details, reasons for the session, experience with energy work, health notes and touch preferences, followed by consent terms the client signs before the session.
Common uses
- Reiki practitioners
- Energy healers and sound healers
- Wellness spas and holistic studios
Key features
- Session type and intentions
- Touch preferences and health notes
- Signed consent as a PDF
What this template asks
What's your full name?
Short Text
What's your email address?
Email
What's your phone number?
Phone
Have you had a reiki or energy healing session before?
Yes / No
Which kind of session is this for?
Single Choice · In person, Distance session, Reiki with sound healing, Not sure yet
What brings you in today?
Multiple Choice · Relaxation, Stress, Sleep, Emotional balance, Grief or life change, Spiritual growth, Something else
Is there anything you'd like the session to focus on?
Long Text · Optional
Are you comfortable with light, hands on touch?
Single Choice · Yes, hands on is fine, Hands above the body only, Ask me during the session
Do any of these apply to you?
Multiple Choice · Optional · Pregnant, Recent surgery or injury, Pacemaker, Under a doctor's care, None of these
Is there anything else your practitioner should know?
Long Text · Optional
Reiki consent
Agreement text, accepted with “I agree”
Sign the reiki consent
Signature
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Reiki consent
Signers read this text in the form before they accept it. Edit the bracketed details to match your business, and have the wording reviewed for your situation.
Please read this before you sign.
This agreement is between [Business name] (the "Practitioner") and the client named in this form.
- What reiki is. Reiki is a gentle energy practice for relaxation. It is not medical care and does not replace care from a doctor or licensed professional.
- No diagnosis. The Practitioner does not diagnose conditions, prescribe medication or tell clients to stop any treatment.
- Touch. The Practitioner follows the touch preference above, and the client may ask to change it or stop the session at any time.
- Results. Experiences differ from person to person, and no specific result is promised.
- Health notes. The client has shared any health details that matter and will tell the Practitioner if anything changes.
- Cancellations. Sessions cancelled less than [number] hours before the start time cost [fee].
By signing below, I confirm that I have read this consent and agree to it.
Frequently asked questions
What should a reiki intake form include?
Contact details, past experience with energy work, the session type, what brings the client in, touch preferences, health notes and a signed consent. This template includes each one.
Does it work for distance reiki?
Yes. Clients pick distance session and fill out the form from home, so you have their intentions and consent before you begin.
Can other energy healers use it?
Yes. Sound healers, crystal healers and other energy workers can edit the session types and consent text to fit their practice. The consent is a sample to start from, not legal advice.