Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth of the person who will receive the treatment.

MM

DD

YYYY

Guarantee of Benefits *

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.

Yes, I understand

No, it's not clear to me how Reiki Energy works

Data Consent *

I consent to the information provided on this form being used by Tanya Whannell to answer my query and provide me with the services requested.

I agree