Questionnaire

I would like a session in:
Counseling Reiki
Your Name:(required)
Email:(valid email required)
Gender:
Male Female
Age:
Relationship Status:
Occupation:
Briefly describe why you are interested in having counseling or Reiki.
Are you experiencing, or have you recently experienced, any physical symptoms or illness? Please explain, and be as specific as possible.
Are you experiencing, or have you recently experienced, stressful events or changes in your life such as job loss, marriage, divorce, death of a loved one, move to a new home, personal illness or an illness of someone close to you?
In addition, are you experiencing, or have your recently experienced, any particular emotional distress? This may include anxiety, sadness, or other feelings? 14. Do you think these feelings are linked to any particular events in your life? If so, please describe them.
Do you have a spiritual challenge you would like me to know about?
Do you have a particular religious affiliation or belief?
What are the most important goals you want to achieve for yourself, or changes you would like to make in your life right now?