2304 Hancock Dr, 7C, Austin, TX 78756
512-775-7782  |  Email

Austin Reiki and Energy Healing Services

Client Intake Form

Please schedule your appointment before submitting your intake form.

* Required Field
* Date:
* Name (First and Last):
* Mailing Address (Street, City, State, Zip Code):
* Home Phone:
Mobile Phone:
* Email Address:
Birth Date:
Age:
How did you hear about PathFinder?
* Do you have any condition that might affect your ability to lie comfortably and relaxed on a massage table? Yes
No
* On a scale of 1-10, with 1 being the least, select the number that represents your level of stress most days. 1
2
3
4
5
6
7
8
9
10
* Which of the following generally describes what you would like most to accomplish from your energy therapy sessions? General stress relief and rebalancing
Physical healing
Emotional healing or issues
Spiritual development or consciousness expansion
Not sure
Comments or additional information you would like to share about yourself or your situation
* May I call or email you after a session to ask how you are doing? Yes
No
If you answered "yes" above, which contact method do you prefer? Phone
Email
Text Message
No preference
* Medical Disclosure: Energy healing is not medical treatment & does not replace appropriate medical care by a licensed professional. Energy therapists do not diagnose or treat medical conditions & will not interfere with treatment by licensed professionals. Energy healing is used only to balance energy fields of the body. It is your full responsibility to seek & use medical care as you would see fit to do without holistic complementary practices. I have read and understand the medical disclosure stated here.