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.