Reiki Experience Form

* Required

Name

I've learned upto Reiki Level * 1 2 3A

I'm practicing Reiki since

Please note that the following questions apply not only to you, but also anyone you might have healed. For example, even if you have never had a headache, but healed a friend who did, you would still tick the 'headache' option below.

Reiki has helped me heal(Physical problems - tick all that apply)

Headache/ Migraine	Sinusitis
Indigestion	Constipation
Insomnia (Sleeplessness)	Overweight problem
Breathing problem	Backache
Other:

Reiki has helped me eliminate (Emotional problems - tick all that apply)

Stress/ Anxiety	Anger
Depression	Relationship problems
Other:

Thanks to Reiki, I am(Personal life - tick all that apply)

more efficient at work	able to have better relationships
having more friends	a happier, calmer person
a more spiritual person	able to study and score better marks
Other:

Reiki has helped me

charge my cellphone	with other electronic devices
get a rickshaw/ bus easily	catch my flight/ train on time
stop rain/ get shelter	get better mileage with my bike/car
heal my plants	heal my pets (mention in 'Other')
Other:

Any additional comments?