Distance Healing Application

    Your Name (required)

    Your Email (required)

    Subject
    Distance Healing Application

    Have you been treated by Distance Healing previously?
    YesNo

    Telephone number

    What are the best times to call you?

    Do I have permission to work with your personal energy through distance healing?
    YesNo

    Briefly, what health concern do you have that led you to seek Distance Healing? If this is a maintenance healing request, please let me know.