Your Name (required)
Your Email (required)
Date of Birth OR Year of Birth
Your Phone Number
Your Full Address (Street, City, State/Province, Country, Zip/Postal Code)
Q1. For whom is this treatment? Include all names, and your relationship to the Reiki recipient(s). Has he/she/they given you consent to receiving this treatment?
Q2. Describe the condition, situation or event for which you are requesting Reiki?
Q3. Even if the treatment is meant for say grievance over a pet, or to boost the memory of someone doing an exam, please give a brief medical history of the Reiki recipient, and include the current medication the recipient takes. Provide specific details. For example, in case of heart issues, you must indicate if the recipient has a pace maker. If you have cancer, where is it located and has it spread, etc.
Q4. What are the usual symptoms of the condition/situation for which you want Reiki?
Q5. Do you see the recipient as an optimist? Describe...
Q6. Describe your/the recipient's lifestyle in terms of smoking, drinking, eating, and exercise habits.
Q7. How familiar are you/the recipient with energy healing? Explain...
Q8. Do you/the recipient have any scheduled clinical or surgical procedures coming up? Please specify date and time.
Q9. Are you/the recipient changing any of your doctor's recommendations to consider this treatment?
Q10. Do you understand that I cannot guarantee any benefits you/the recipient might receive from treatment? Reiki goes where it's most needed and it's your soul who decides how to use the Reiki energy for your highest good.
Q11. What emotional challenges are you currently working on (eg. as a result of your physical illness)?
Q12. Please indicate any other problems/issues that bother you that you haven't told me yet.
Q13. While believing is not a prerequisite for successful treatment, I would like know to which degree you believe in this Reiki treatment. Rate yourself from 1 (extremely skeptical) to 5 (completely identify with energy healing concept)
Q14. What day and time of the day do you prefer to receive treatment?
My Schedule: Distance Reiki can be during the day or evenings. In-person treatment times are weekdays 9 am-3 pm GMT +1. Evenings / weekends are for exceptions. Reiki training workshops are usually in the weekends.
Q15. If you are applying for distance reiki, please use the upload file feature below for a photograph of your face/the recipient. There's no need to email me a picture for in-person treatment.
Last but not least, a formality so that there are no legal issues. Please read and accept below:
"In my free will, I acknowledge that I am fully aware that Astrid Lee is not a medical doctor nor medical practitioner. I affirm that not in any way has she represented herself as possessing any medical expertise or medical training whatsoever, and she has not prescribed, diagnosed or treated or recommend any particular treatment or medication or substance for me in respect of my injury, ailment or disease that I may possess.
I have not been cajoled, coerced, threatened or persuaded by Astrid Lee to undergo or partake in any particular treatment or medication or substance. Thus, I freely acknowledge that any unorthodox or unusual treatment or medication or substance that I may utilize is done with my full awareness and acknowledgement that it is of my own free will.
I, the undersigned, for myself, the person I am applying for, my heirs, their heirs, successors, executors, administrators and assignees, hereby release and forever discharge Astrid Lee, her heirs, successors, executors, administrators and assignees, from any and all actions, causes of action, claims and demands for or by reason of any damage, loss or injury, to person and property which heretofore has been or hereafter maybe sustained in consequence of attending a workshop, or taking any medication, substance or treatment which I may use or consume in any respect of and for any attempts by myself or anyone on my behalf to cause temporary or permanent relief from the symptoms of any injury, ailment or disease with which I have been or will be diagnosed."
To acknowledge the DISCLAIMER, you MUST check the box on the left. If you are acting on behalf of a Reiki Recipient who is not you, you are committing both yourself and the recipient with your acceptance.
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Thank you for your Reiki application form. I will be in touch with your shortly to organize a Reiki session.