# 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.

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.

Canonical: https://reuily.com/templates/reiki-intake-form
Use this template: https://reuily.com/form/from-template/reiki-intake-form
Collections: Requests & Intake, Agreements & Waivers, Beauty & Wellness, Holistic Wellness
Last updated: 2026-10-24

## Questions

- Question 1: What's your full name? (Short Text, required)
- Question 2: What's your email address? (Email, required)
- Question 3: What's your phone number? (Phone, required)
- Question 4: Have you had a reiki or energy healing session before? (Yes / No, required)
- Question 5: Which kind of session is this for? (Single Choice, required). Options: In person; Distance session; Reiki with sound healing; Not sure yet
- Question 6: What brings you in today? (Multiple Choice, required). Options: Relaxation; Stress; Sleep; Emotional balance; Grief or life change; Spiritual growth; Something else
- Question 7: Is there anything you'd like the session to focus on? (Long Text, optional)
- Question 8: Are you comfortable with light, hands on touch? (Single Choice, required). Options: Yes, hands on is fine; Hands above the body only; Ask me during the session
- Question 9: Do any of these apply to you? (Multiple Choice, optional). Options: Pregnant; Recent surgery or injury; Pacemaker; Under a doctor's care; None of these
- Question 10: Is there anything else your practitioner should know? (Long Text, optional)
- Agreement: Reiki consent, accepted with "I agree" (full text below)
- Question 11: Sign the reiki consent (Signature, required)

Signing records the signer's consent, email, IP address, browser and signing time, and each signer can download a signed PDF copy.

## Reiki consent

Please read this before you sign.

This agreement is between **[Business name]** (the "Practitioner") and the client named in this form.

1. **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.
2. **No diagnosis.** The Practitioner does not diagnose conditions, prescribe medication or tell clients to stop any treatment.
3. **Touch.** The Practitioner follows the touch preference above, and the client may ask to change it or stop the session at any time.
4. **Results.** Experiences differ from person to person, and no specific result is promised.
5. **Health notes.** The client has shared any health details that matter and will tell the Practitioner if anything changes.
6. **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.

## 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

## 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.