Distant Reiki Session

20 - 30 minutes ($25.00)

Long Distance Reiki agreement and request form

*Legal Stuff (waiver)*

* Please read the above waiver note before filling in the request form.  By filling in the request form you are indicating your understanding and agreement to this treatment relationship.  After receiving your information and payment, we will confirm the details by email.  

 

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Request Form for a Distant Reiki Session

The information that is required is indicated by * and in bold text.
The rest is completely optional.

First Name:*
Last Name:*
Email:*
Address:
City:*
Province/State:
Postal/Zip Code:
Country:*
Requested Date:*
Requested Time:*
Verification No.:*
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*Remember that the times chosen are PST.  If you need to check the conversion for your time zone click here.

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