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If you wish to book your first session / Become a member, please fill out our form, and we will get back to you as soon as possible

First name*

Last name

Email*

Phone*

Gender*

Female

Male

Non-Binary

Treatment*

Reiki

Sound Healing

Massage

Reasons for treatment*

Medical conditions

Are you pregnant ?

Yes

No

Name and relation of emergency contact

Emergency contact info

I confirm all information provided is correct to the best of my abilities

Pre-Consultation Form

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