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Reiki Session Intake & Client Intention Survey

A pre-session intake for reiki and energy healing practitioners that captures a client's physical and emotional state, comfort with touch, and health considerations before hands-on work begins. An AI follow-up interview digs into the client's stated intention so practitioners can tailor the session to what's really driving the visit, not just the surface request.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

13 questions · ~7 min
Q01
Message

Welcome, and thank you for taking a few minutes before your session. These questions help your practitioner understand your goals, comfort level, and any health considerations so the session can be tailored to you. About 5 minutes, and everything you share stays confidential.

Q02
Multiple Choice

Have you received a reiki or energy healing session before?

  • This is my first time
  • A few sessions before
  • I receive sessions regularly
  • Not sure / no prior experience with this type of work
Q03
Long TextRequired

What would you most like to focus on or address in today's session? (For example: physical tension, stress, sleep, emotional overwhelm, or something else.)

Q04
MatrixRequired

How would you describe each of the following right now?

5 rows × 4 columns
  • Physical tension or pain
  • Emotional stress
  • Sleep quality
  • Overall energy levels
  • Mental clarity or focus
Columns: No concern · Mild concern · Moderate concern · Significant concern
Q05
Opinion ScaleRequired

Over the past week, how would you rate your overall stress level?

Scale: 1 – 10
Min:Not stressed at allMax:Extremely stressed
Q06
Multiple ChoiceRequired

What is your preference for physical contact during the session?

  • Light hands-on touch
  • Hands held just above the body, no touch
  • A mix, practitioner's discretion
  • No preference
Q07
Long TextRequired

Please list any injuries, recent surgeries, pregnancy, medical conditions, or specific areas of your body we should avoid touching or hovering over.

Q08
Multiple Choice

Do you have sensitivities we should know about for the session environment?

  • Bright light
  • Sound or music
  • Scents or aromatherapy oils
  • Room temperature (prefers warmer/cooler)
Q09
AI Interview

Explore the client's stated intention for today's session in more depth: how long they've been feeling this way, what prompted them to seek a session now, and what a genuinely successful outcome would feel or look like afterward. If their answer was vague or purely physical, gently probe whether there's an emotional or life-circumstance dimension underneath it, without being clinical or pushy.

Q10
ConsentRequired

Please confirm your consent before your session begins.

Q11
Multiple Choice

How did you hear about this practice?

  • Friend or family referral
  • Online search
  • Social media
  • Local wellness event or studio
  • Other
Q12
Multiple Choice

Which age range best describes you?

  • Under 25
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65 or older
  • Prefer not to say
Q13
Message

Thank you for sharing this with us. Your practitioner will review your responses before your session to make it as comfortable and effective as possible. See you soon!

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • Goes beyond a static intake checklist with an AI follow-up interview that explores the client's stated intention in more depth — how long they've felt this way, what's driving the visit — so practitioners understand the real reason for the session, not just the surface request.
  • Captures physical and emotional state in structured detail via a matrix question and a 0-10 stress opinion scale, alongside open text for injuries, surgeries, pregnancy, and medical conditions.
  • Explicitly addresses comfort with touch (a multiple-choice preference question) and environmental sensitivities before hands-on work begins, plus a dedicated consent step.
  • Automated per-response quality scoring and an auto-generated report mean practitioners get a ready-to-read client summary rather than raw form dumps to review manually.

Jotform

Reiki Intake Form Template

A static, fielding-ready reiki intake form built on Jotform's drag-and-drop form builder. It covers standard intake fields (contact info, health history, consent) but is a fixed form rather than an adaptive interview. Good for practitioners wanting quick setup with e-signature and widget integrations.

What it does well

  • Easy to customize with Jotform's widget/template ecosystem
  • Likely supports e-signature and file uploads for consent
  • Fast to deploy with no coding needed

Where it falls short

  • No adaptive AI follow-up to probe deeper into client intention — questions are fixed once published
  • No voice AI interview option
  • No automated per-response quality scoring or generated client report

SurveySparrow

Reiki Intake Form Template

A conversational-style reiki intake form using SurveySparrow's chat-like UI, presenting questions one at a time. It's a ready-to-field template but relies on pre-written questions rather than dynamic probing based on client answers.

What it does well

  • Conversational one-question-at-a-time flow feels more personal than a flat form
  • Mobile-friendly design
  • Supports branching logic for basic personalization

Where it falls short

  • No AI-driven follow-up interview to dig into what's really behind a client's stated intention
  • No voice AI interview mode
  • No transparent, publishable prompt methodology or automated quality scoring

Typeform

Reiki Intake Form Template

A polished, ready-to-field reiki intake template with Typeform's signature conversational UI and logic jumps. Strong on presentation and simple branching, but questions are pre-set and static rather than adaptive to each client's response.

What it does well

  • Clean, on-brand conversational interface
  • Logic jump branching for basic conditional paths
  • Wide integration options (calendars, payment, CRM)

Where it falls short

  • No adaptive AI interview or voice AI capability to explore intention beyond the written prompt
  • No automated per-response quality scoring
  • No auto-generated practitioner-facing report

SurveyMonkey

Client Intake Form Template

This is a generic client intake template, not a reiki- or energy-healing-specific form — practitioners would need to substantially rebuild it to cover touch preferences, energy-work terminology, or session intention. It's fielding-ready for generic use but not tailored to this niche.

What it does well

  • Backed by SurveyMonkey's established survey analytics and reporting
  • Flexible generic intake structure adaptable to many service businesses
  • Reliable distribution and response collection infrastructure

Where it falls short

  • Not built for reiki/energy healing specifics — no comfort-with-touch or intention-focused questions out of the box
  • No adaptive AI follow-up interview or voice AI option
  • No automated quality scoring of individual responses

Ready to launch?

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