About this template
The Reiki Intake Form is an essential tool for energy healing practitioners to streamline their administrative workflow. By gathering client details, health history, and treatment goals before the session begins, practitioners can focus entirely on the healing experience rather than paperwork. This template helps you establish a professional standard of care while ensuring you have the necessary context to provide a personalized treatment.
This form captures vital information including contact details, medical history, and specific wellness goals. It also serves as a critical touchpoint for obtaining informed consent, ensuring that both the practitioner and the client are aligned on the nature of the energy work. By using Doc2Form to deploy this as a Google Form, you can automatically organize responses in a spreadsheet, making it easy to review client history before every appointment.
Key features
- Collect essential health history and contact info in one place.
- Standardize your intake process for every new client.
- Easily share via email or website link before appointments.
- Organize all client data automatically in Google Sheets.
- Include clear consent sections for professional practice.
Use cases
- New client registration for private Reiki practices.
- Pre-session health and wellness goal assessment.
- Collecting digital consent for energy healing services.
What this form collects
- Full Name (Short answer)Please enter your full legal name.
- Date of Birth (Date)Used for our records.
- Email Address (Short answer)We will use this to send appointment reminders and session notes.
- Phone Number (Short answer)Best number to reach you at if we need to reschedule.
- What are your primary goals for this session? (Paragraph)Are you seeking stress relief, physical pain management, or emotional balance?
- Health History & Notes (Paragraph)Please list any injuries, surgeries, or medical conditions we should be aware of.
- Informed Consent (Multiple choice)I understand that Reiki is a relaxation and stress-reduction technique and does not replace medical treatment. I agree to receive this service.
- Digital Signature (Short answer)Please type your full name to serve as your digital signature for this form.
FAQ
Can I add my own questions to this form?
Yes, once you convert this template to a Google Form, you can easily add, edit, or remove questions to suit your specific practice needs.
How do I share this form with my clients?
You can send the form link directly to clients via email, text, or embed it on your website for easy access before their first appointment.
Where is the client data stored?
All responses are stored securely in your personal Google Drive, linked to the Google Form created from this template.
Is this template suitable for other types of holistic therapy?
Absolutely. While designed for Reiki, the structure is easily adaptable for massage therapy, meditation coaching, or other wellness services.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.