Intake Form — adriana koc spadaro

Email

Address

Emergency Contact Name

Emergency Contact Phone Number

If yes, is there anything that you'd like to share about your experience?

If yes please provide their name

Are you sensitive to any perfumes or fragrances?

Do you have an area of particular concern?

I understand that reiki and energy work is a technique used for stress reduction and relaxation. I understand that energy work does not replace medical care. It is recommended that I see a licensed physician or health care professional for any physical or psychological ailment I may have. I understand that energy work can complement any medical of psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation can be beneficial.

Please complete the form 24 hours before your appointment.