HAIR & SCALP RITUAL INTAKE

Welcome!

Thank you for booking a Hair & Scalp Ritual experience. This form helps me personalize your service and create an experience that supports both your scalp health and overall well-being.

First name

Last name

Email

Phone

Hair & Scalp Concerns

How often do you wash your hair?

Daily

Every 2-3 days

Weekly

Other

What products are you currently using?

Have you experienced any significant changes recently that may affect your hair or scalp? Examples: Stress, illness, surgery, medications, hormonal changes, pregnancy, major life changes

Allergies & Sensitivities

Are you sensitive to fragrances, essential oils, or strongly scented products?

Do you have allergies or sensitivities to any ingredients commonly found in haircare products?

Do you have any scalp conditions I should be aware of?

Experience Preferences

How would you prefer the atmosphere during your appointment?

Mostly quiet

Light Conversation

Educational and informative

A balance of both

Have you ever received Reiki before?

Yes

No

Would you like Reiki to be incorporated into your service?

Yes

No

Unsure

Please Read:

I understand that Reiki is a simple, gentle, hands-on energy technique used for relaxation and stress reduction. Practitioners do not diagnose conditions nor do they prescribe substances, nor interfere with treatment of a licensed medical professional. I understand that reiki does not take the place of medical care. It is recommended that I see a licensed health care professional for any physical or phsychological ailment I may have. I understand that Reiki can compliment any medical treatment I am receiving.

Reiki services will be infused through the appointment and is completely optional

I am ok receiving reiki during my service

I've read and understand the above paragraph