Client Information Form - Northern Beaches Reiki and Meditation Studio

New Client Information Form

We appreciate you filling out our client contact/information form.

This information is for our records

Your privacy is valued and respected.

Thank you.

Full Name

Address

Date of Birth

Do you take any prescribed Medicine that we need to be aware of? ( please summarise)

Reason for Visit

I understand that Reiki Practitioners do not diagnose conditions, prescribe any form of medication, perform medical treatments, offer advice about treatments from a licensed medical profession,

I understand that Reiki Treatments are not a substitute for medical or psychological diagnosis and treatments

May we contact you from time to time with useful information and special offers?

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Client Contact Form

New Client Information Request