If the patient communicates with you in advance, ask them to wear comfortable loose-fitting clothes. Once they come for the healing, ask them to remove their spectacles, watch, jewelry, belt, etc. Gold and silver jewelry may be worn. Make sure you and the patient both drink a glass of water.
Ask them to lie down comfortably on their back and close their eyes. Start by healing the crown/ brow chakra, and then continue to heal all the front chakras.
Once done, balance the energy by spiralling. That is, keep your left hand on their right shoulder, and with your right hand (Index and middle finger extended, thumb touching the ring and little finger) draw anticlockwise spirals starting from the left shoulder, to the tip of the left hand. Next, draw the spirals from the left shoulder to the left foot, then from the right shoulder to the right foot, and then, right shoulder to the tip of right hand.
Ask the patient to turn over the right side and lie on their stomach. Heal the back chakras.
The next step is balancing. Hold your hands above the back brow and back root chakras, about 6 inches above the body. Try to feel the imbalance of energies, and give Reiki till the energy levels feel the same. Then move your hands slowly to the back throat and back hara chakras. 
Once these chakras are also balanced, move slowly to the back heart and back solar chakras. When these two chakras are balanced, bring both your hands over the back heart chakra and rest it over the body.
Keep your left hand on the patient's left shoulder. With the index and middle finger of your right hand, form a V shape and draw a line from the throat to root chakra. If the patient is diabetic, then draw a line from the root to the throat chakra. Rest your right hand on his/ her back hara chakra. Do this thrice. Gently awaken the patient.
There are several ways of sending distant energy. You could use an object as a surrogate, a photograph, an intention slip, imagine them, or send them reiki through your third eye. Each of these points is covered in detail.
Using a Photograph
You could ask the patient for a photograph and send reiki energy to the same. Draw the symbols at the back of the photograph and if there is enough space, you might even write above it that their problem is solved. Hold the photograph between your palms and imagine the symbols on it while giving Reiki.
Using a Surrogate
You could use a stuffed toy or a similar object as a surrogate. Mentally declare the toy to be the patient and start giving it Reiki. You can give Reiki to the affected part or give full body Reiki to it. You could also declare small objects or your thumb as the patient, and hold it between your palms and give reiki.
Imagination
Keep your palms cupped together and imagine the person either inside your palms or in front of you, receiving the energy you send and bathing in it. Imagine them feeling better, and draw the symbols while giving them reiki.
Third Eye
If the person is visible, you can imagine reiki energy coming through your third eye and going to that person. Imagine a beam of Reiki coming out through your third eye, and draw the symbols on them with that beam. You could use this technique when you are looking at their photograph or simply imagining that they are standing in front of you and receiving reiki through your third eye.
Intention Slip
You could have an intention box, something which can fit into your palm and contain rolled up papers. Take a small chit of paper and write your intention on one side. Take care to use only positive words (avoid using 'no', 'not', 'don't', 'won't', 'can't', etc), avoid any full stops (period .) and don't fold the paper. After the intention, end it with 'It is so, Thank you Reiki, Thy will be done'. On the opposite side of the paper, draw all the symbols. Roll it up and put it in the intention box.
The advantage of the intention box is that you can give Reiki to a lot of people/ events at the same time. Whenever you wish, hold the box between your palms, mentally draw the symbols on it and give Reiki. You don't have to think of all the intentions individually.
Intension slip and imagination techniques can be used for this type of healing. You can also mentally declare 'XYZ event is successful. It is so, Thank You Reiki, Thy will be done' while giving Reiki. The first line may be subtituted with different statements depending on the circumstance.
Reiki can also be sent for past events which still hurt/ makes a difference in your life. This is especially helpful for those with childhood traumas and broken relationships. Reiki cannot change the past, but it will change the way you feel about the event in question, and also helps you forgive the people involved.
When a person gives you his consent for accepting Reiki, two important things are happening subconsciously. Firstly, by consenting, he is opening himself up to any energy that you might send his way. Secondly, and more importantly, consenting also tells his subconscious mind to start preparing to be healed, and his own body starts actively trying to heal itself.
Even though it is hard to accept, we are never sick unless we truly want to be. We are talking at a subconscious-mind level over here, because consciously, we often seem completely fed up with our ailments. In such cases, consent sets the path for a faster recovery. When someone asks for Reiki, they are asking for help to get better, and that itself sends a big message to his subconscious.
In cases when you do not ask for a person's consent, that person continues to remain in the same mental and subconscious state of enjoyment, and it is much harder and takes much longer, if at all he is cured. For this reason, we encourage taking consent.
If a person is in a state of unconsciousness or in some other way unable to give consent, it is quite alright to send loving Reiki energy their way. In cases where you want to free another person of addiction or disease without/ against their consent, improvement may be negligible.
However, others believe that we receive energy and help from various people, sometimes strangers, who do not charge us, and we should give Reiki free as nature will balance the energy out. They believe that it does not matter whether a person values Reiki or the treatment, and that they should work towards helping others without asking for anything in return.
Most people regard Reiki as sacred and not to be given away free. They argue that one does not give away gold for free, then why Reiki? Reiki given free is considered charity, much along the lines of free food or clothes. They usually charge a fixed fee, and if the patient is too poor, charge a day's salary or some service.
Both these view points are not wrong, as every Reiki channel is guided by Reiki. If you are in a dilemma, let Reiki be your guide, and follow your intuition.
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