Pre Appointment Screen

ANTHONY LARKIN

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Reiki Candle Crown Chakra

Pre Health Check for all Clients.
This Client Profile Questionnaire MUST be completed before your appointment.
Your information will be kept in the strictest of confidence and inline with the GDPR 2018.

* Indicates required field

Name: *

Mobile: *

Email: *

Please answer the questions truthfully and honestly by ticking the associated box.
If you tick a box, please leave comments in the free text field at the bottom of this page giving more information.

Tick boxes if answer is yes: *

I have difficulty in conversing in the English language. I suffer with hearing loss, or find it difficult to hear when people are speaking. I am currently under medical supervision. I have difficulty lying on my back. I have allergies / sensitivity to incense sticks, oil burners or scented candles. I am unable to climb up and down a flight of stairs independently. I have read all of the above and I will disclose any information required in the box below. If nothing to disclose, please type in the word (NOTHING) and click Submit Are there any specific physical issues (e.g., pain, fatigue, illness) you would like to address in this session? Are there any emotional or spiritual challenges you are currently facing that you would like to focus on? What are your main intentions for this Angelic Reiki session? (e.g., healing, clarity, stress relief, spiritual guidance)

Use this text box below to give me more information if you did not tick any of the boxes above.
(All of the information on this form or disclosed in your session is completely confidential)

Comment *

Submit

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Home
Meet Anthony
- Spiritual Author
ANGELIC REIKI
QHHT
- Qhht Questions
Pricing | Booking
Contact
- Booking Policy
- Pre Appointment Screen
Reviews
Reiki Candle Crown Chakra