✨ Booking Request Form ✨

Please fill out the form below to request your Reiki session. We’ll reply by email to confirm your booking and provide details.

First Name
Last Name
Email Address
Preferred appointment date (Option 1)
Select your desired date.
Select Your Preferred Time (Option 1)
Please tap the Japanese text below to select your preferred time.
Preferred appointment date (Option 2)
Select your desired date.
Select Your Preferred Time (Option 2)
Please tap the Japanese text below to select your preferred time.
Preferred appointment date (Option 3)
Select your desired date.
Select Your Preferred Time (Option 3)
Please tap the Japanese text below to select your preferred time.
Session Type
Please choose your preferred setup (same price).
Session plan
Please choose your preferred Reiki session plan (both include a 70-minute treatment).
Food Allergies or Dietary Restrictions
If you selected the “Tea & Memory Set,” please let us know about any food allergies or dietary restrictions.
What is your main language? (for translation support)
We use a translation app to support multiple languages.
If you selected “Other,” please write your language in English below.
Message for our Clinic
Any other requests or questions?
Note:
We’ll do our best to accommodate your requests, but availability of tatami/bed and the Tea & Memory Set may vary by day. Thank you for your understanding.
※ Please complete the CAPTCHA below before submitting.
Check the box, enter the characters, and tap the black button「回答」to confirm. If needed, tap the 🔄 button to refresh the image.
*Your appointment is not confirmed until we reply. By submitting this form, you agree to our Privacy Policy.