Referral

Harambee House of Wellness

Welcome! This form is to get you scheduled for a reiki session through our referral system.

* Indicates required field

Your Name *

First

Last

Your Phone Number *

Your Email *

Your City & State *

Why do you want/need reiki? *

Choose best time to come in for a session. *

Tuesday's 11am Tuesday's 2pm Wednesday's 11am Wednesday's 1pm Thursday's 11 am Thursday's 1pm Sunday's 11 am (limited spots)

Sunday's are limited and are prone to longer wait times to be scheduled.

Who referred you? *

First

Last

Best form of contact. *

Phone Call Email

Phone calls are preferred, this helps me get to know your needs on a personal level.

Best time to Contact you. *

Morning (9am-11am) Afternoon (12pm-4pm) Evening (5pm-7pm)

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