Distant healing booking form

🌟 Please complete the form below carefully

Proxy application: We can accept applications from family members within 3 degrees of kinship without needing their consent (eg: parents, children, siblings, grandchildren, aunties & uncles, nephews & nieces, grandparents, great-grandparents, husband & wife who have been officially married). Beyond three degrees of kinship or for a friend/colleague, you MUST ask the person if they wish to receive healing and get their permission, otherwise the healing energy is unlikely to work if they have not given their permission.

DETAILS OF THE PERSON WHO IS FILLING OUT THIS FORM:

First Name

Last Name

Email

DETAILS OF THE PERSON WHO WILL RECEIVE THE HEALING:

First Name

Last Name

Date of Birth: DD/MM/YYYY

Full Address, (including country)

Tick this box if the person will be away from home or travelling at the time of the healing.

Briefly explain what would you like to be focused in the distant healing?

Please write the preferred Date & Time for the Healing (excluding weekends & public holidays): *Please choose a time which is at least 24 hours after submitting this form and making payment. Please enter the time as the Local Time of your country.

In the event that we are unable to allocate your date/time, we will contact you with an alternative.

Where did you hear about us?

Distant healing booking form

🌟 Please complete the form below carefully

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