Distance Reiki Session Note

Date/Time: [Session date] [Start time]–[End time] [Time zone]

Client: [Client full name], [DOB]

Practitioner: [Practitioner name], [Credentials], [Practice name]

Modality: [synchronous video / synchronous audio-only / asynchronous] (If asynchronous, briefly specify how the session was conducted.)

Platform: [Technology/platform used]

Client Location: [Client full address at time of session] (If location cannot be confirmed, document this and note whether session was deferred.)

Consent & Safety

• [Consent confirmation for this session, including acknowledgment that distance Reiki is a non-contact wellness service and not medical treatment]
• [Identity verification method used]
• [Emergency contact name and phone; authorization to contact in emergency: yes / no]
• [Disconnection plan: who contacts whom, time frame, escalation criteria] (Only include for synchronous sessions.)

Intention & Pre-Session Status

Client Intention: [Client-stated intention or reason for session / Client requested general relaxation and support without a specific intention] (Attribute to client report.)

• [Interval changes since last session] (Only include if follow-up visit; attribute to client report.)
• [Pre-session symptom ratings (0–10) for relevant domains, e.g., stress, pain, fatigue, sleep quality] (Format as Domain: rating/10.)
• [Red flags or concerns that may warrant medical referral] (If none, omit this bullet.)

Session Details

(Describe focus areas as energy centers rather than anatomical treatment targets. Include duration and general approach.)

• Total Reiki time: [Total minutes] (Note any interruptions or connection issues if applicable.)
• Session structure: [Opening/grounding] | [Focus areas with approximate durations] | [Closing/integration]
• Adjuncts: [Guided imagery / breathwork / music / none]
• No physical touch occurred.

Response & Outcomes

(Use non-medical, non-causal language. Attribute findings to client report or observation via the modality used.)

• In-session experiences: [Client-reported sensations, emotions, relaxation response]
• Post-session ratings: [Paired comparisons using same domains as pre-session, e.g., "Stress: 8/10 → 4/10"]
• Adverse or unexpected responses: [Description of any reported, even if mild / none reported]
• Practitioner impression: [Brief impression of tolerance and progress toward client goals] (Avoid medical assessment language.)

Plan

• [Self-care suggestions, e.g., hydration, rest, grounding exercises] (Keep brief and non-prescriptive.)
• [Follow-up plan and timing for next session]
• [Guidance to seek medical evaluation if symptoms are severe, persistent, or worsening]

Practitioner Signature: [Practitioner name, credentials] | [Date/time of documentation]