Rasputin first met the tsar on 1 November 1905, at the Peterhof Palace. The tsar recorded the event in his diary, writing that he and Alexandra had "made the acquaintance of a man of God – Grigory, from Tobolsk province". Rasputin returned to Pokrovskoye shortly after their first meeting and did not return to St. Petersburg until July 1906. On his return, Rasputin sent Nicholas a telegram asking to present the tsar with an icon of Simeon of Verkhoturye. He met with Nicholas and Alexandra on 18 July and again in October, when he first met their children. At some point, the royal family became convinced that Rasputin possessed the miraculous power to heal Alexei, but historians disagree over when: according to Orlando Figes, Rasputin was first introduced to the tsar and tsarina as a healer who could help their son in November 1905, while Joseph Fuhrmann has speculated that it was in October 1906 that Rasputin was first asked to pray for the health of Alexei.

The Imperial Family's belief in Rasputin's healing powers brought him considerable status and power at court. Rasputin used his position to full effect, accepting bribes and sexual favors from admirers and working diligently to expand his influence. Rasputin soon became a controversial figure; he was accused by his enemies of religious heresy and rape, was suspected of exerting undue political influence over the tsar, and was even rumored to be having an affair with the tsarina.