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Please note: Starting in March 2023, Fieldstone Veterinary Care is going to be closing every other Saturday.

Online Form

Reiki Intake Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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Reiki Intake Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 203-746-5555 for a faster response.

Animal Name *

Species *

Name of Person Requesting Reiki for the Animal *

First

Last

Email *

Phone *

I consent to receive SMS text messages from Fieldstone Veterinary Care. Msg & data rates may apply. Reply STOP to opt-out. *

Best Days/Times to Reach You *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Where does the animal live? *

It is best to treat animals where they live or from a distance if possible.

Do you have a particular area of concern you would like us to focus on?

Is the pet currently receiving any medical treatment, or taking any medications for known medical health conditions? *

Do you have any questions?

How did you hear about us? *

Has the animal had Reiki before? *

Please refrain from wearing any scented product to appointments.

Privacy Notice:

No information about any pet or pet family will be discussed or shared with any third party without written consent of the pet owner.

Cancellation policy & fees

In the event you find you must cancel a scheduled appointment, please allow 24 hours notice. We will try to reschedule your appointment in following two weeks so that the animal does not miss the treatment benefit. You will be charged the full fee for your session if you cancel or change your appointment with less than full day advance notice. It is my policy that you pay the entire fee at the time of each session - preferably at the beginning of the session so that it will not interfere with the flow of our work. If you would like to arrange another payment option please let me know, pay pal is available for your convenience.

I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of veterinary care. It is recommended that the animal see a licensed veterinarian for any physical aliment they may have. I understand that Reiki can complement any veterinarian care that the pet may be receiving. I agree that I will inform my practitioner of any significant health changes prior to future appointments. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long- term imbalances may sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. I understand that Reiki practitioners are providing Reiki at my request and are not responsible for the outcome of the session. The animal directs the treatment therefore session length and results vary per each session. *

Signature

Date *

Online Form

Reiki Intake Form

Reiki Intake Form

Privacy Notice:

Cancellation policy & fees

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