Spiritual Space Clearing Application Form

Your Name (required)

Your Email (required)

Date of Birth OR Year of Birth

Your Phone Number

Distance Space Clearing Request Details

Full Address of the space that needs to be cleared (Street, street number, City, State/Province, Country, Zip/Postal Code)

Q1. Who lives or works in this space? Include all names, and your relationship to them. Has he/she/they given you consent to receiving this space clearing?

Q2. Describe the condition, situation or event for which you are requesting space clearing with distance healing with Reiki energy?

Q3. Even if the treatment is meant for non-medical reasons, such as to clear the home after a child goes off to university, please give a brief medical history of the the people in the home, and include the current medication they take. Provide specific details. For example, in case of heart issues, you must indicate if the recipient has a pace maker.

Q4. What are the symptoms of the condition/situation for which you want Reiki?

Q7. How familiar are you/the recipient with energy healing and space clearing? Explain...

Q10. Do you understand that I cannot guarantee any benefits or outcome you/the recipient might receive from treatment? Reiki goes where it's most needed and it's your soul who decides how to use the Reiki energy for the highest good.

Q12. Please indicate other relevant issues that you haven't told me yet.

Q13. While believing is not a prerequisite for successful treatment, I would like know to which degree you believe in this Reiki treatment. Rate yourself from 1 (extremely skeptical) to 5 (completely identify with energy healing concept)
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Q14. What day and time of the day do you prefer to receive session?
Space clearing should happen by daylight.

Q15. Please use the upload file feature below for a photograph of the site that requires space clearing.

Disclaimer

Last but not least, a formality so that there are no legal issues: Please read and accept below:

"In my free will, I acknowledge that I am fully aware that Astrid Lee is not a medical doctor nor medical practitioner. I affirm that not in any way has she represented herself as possessing any medical expertise or medical training whatsoever, and she has not prescribed, diagnosed or treated or recommend any particular treatment or medication or substance for me in respect of my injury, ailment or disease that I may possess.

I have not been cajoled, coerced, threatened or persuaded by Astrid to undergo or partake in any particular treatment or medication or substance. Thus, I freely acknowledge that any unorthodox or unusual treatment or medication or substance that I may use is done with my full awareness and acknowledgement that it is of my own free will.

I, the undersigned, for myself, the person I am applying for, my heirs, their heirs, successors, executors, administrators and assignees, hereby release and forever discharge Astrid, her heirs, successors, executors, administrators and assignees, from any and all actions, causes of action, claims and demands for or by reason of any damage, loss or injury, to person and property which heretofore has been or hereafter maybe sustained in consequence of attending a workshop, or taking any medication, substance or treatment which I may use or consume in any respect of and for any attempts by myself or anyone on my behalf to cause temporary or permanent relief from the symptoms of any injury, ailment or disease with which I have been or will be diagnosed."

To acknowledge the DISCLAIMER, you MUST check the box on the left. If you are acting on behalf of a Space Clearing Distance Reiki Recipient who is not you, you are committing both yourself and the recipient with your acceptance.

Anti-Spam: please type the letters below

Thank you for your Reiki application form. I will be in touch with your shortly to organise a Reiki session.

My PRIVACY POLICY is common sense: I respect the privacy of your contact details and other personal information, will take reasonable care to protect it, and won't sell it.