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* 1. What is your first and last name?

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* 2. Have you experienced Reiki or Sound Healing treatments before?

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* 3. Primary Concerns? (Indicate level between 1-10 with 1-hardly noticeable and 10-unbearable)

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* 4. Medications/Remedies/Supplements & Reasons for taking:

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* 5. Have you had any significant accidents/injuries/surgeries?

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* 6. Please select all conditions that apply (past or present):

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* 7. Are you pregnant?

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* 8. Please select any symptoms you experience currently:

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* 9. Please select any areas you would like improvement in:

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* 10. Describe what you would like to accomplish with these treatments:

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