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Reikinetics Energy Token Request Form

Where intuition meets intention.
Custom visual + energetic words for clarity, healing, or support
Delivered within 24-48 hours (rush available).

What is your name?

Your Email Address
(Where should we send the finished token?)

Who is this for?

Who is this for?

If for someone else, please share their first name only:

What’s going on? In a few words or a short sentence, what’s the current theme, challenge, or situation in your life right now? (Examples: “Starting over,” “Feeling stuck,” “Big creative shift,” “Grief and uncertainty”)

What kind of energy would feel most supportive right now?
(Choose up to 3)

What kind of energy would feel most supportive right now?(Choose up to 3)

Anything else you’d like me to know? (Any specific colors, imagery, symbols or sensitivities?)

What’s been hard lately? What pain point or feeling keeps surfacing, even if you don’t fully understand it? (Examples: self-doubt, disconnection, old patterns resurfacing, body pain, burnout, people-pleasing, fear of the future)

What are you calling in? What would you love to feel, know, embody, or experience next? (Examples: deeper trust, more momentum, feeling safe, being seen, better boundaries, physical healing)

Anything else I should know? Any visuals, colors, symbols, dreams, physical symptoms, or moments you’ve experienced lately that feel connected? (This is your space to share freely, or leave blank if nothing comes to mind.)

Which version would you like?

Which version would you like?

Do you need this urgently?

Do you need this urgently?