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Companion Reiki Client Intake Form


Please fill out and submit the following form at least 24 hours prior to our session.

Client Information
Companion Information
Can you describe what a typical day looks like for your companion? Please include the sleep times, activities (including types and durations) contact with other animals, food types and amounts, as well as times and locations spent with you (kennel, field, home, etc.)
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I understand that the Reiki session(s) for my companion, is intended to provide relaxation, reduce stress, promote overall health and well-being.  I understand that Reiki practitioners do not diagnose conditions, prescribe veterinary medication, perform medical treatment of any kind or interfere with the treatment of any licensed veterinarians or other medical professionals.

Furthermore, I understand that:

  • Reiki is not a substitute for veterinary care or medicine and that I may need to receive permission from my veterinarian in order to request Reiki sessions.
  • Reiki sessions with Adrienne Bentley are totally voluntary and I may choose to end the session for my companion at any time.
  • Reiki can complement any veterinarian care that the animal 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 by session.
  • I authorize Adrienne Bentley to offer Reiki session(s) to my companion.
  • The safety and care of my companion is ultimately my responsibility.

Thanks for submitting!

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