Distance Reiki Client Information

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DISTANCE REIKI

CLIENT INFORMATION

Prior to a Distance Reiki session with Victoria, all clients are asked to please complete this information form and agreement.

Name

Email

Phone Number

Are you currently under the care of a physician?

Yes

No

If yes, please provide the physician's name

How did you hear about Refined by V?

Have you ever had a Reiki session before?

Yes

No

If yes, when was your last session?

Do you have a particular area/s of concern?

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