REQUEST FOR HEALING SESSION

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Name *

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Phone Number *

Gender *

Best time to contact: *

Email *

Do You Belive in Angels *

How long have you been dealing with this issue? *

Would you be willing to allocate 30 minutes a day to self empowerment? *

Please answer following questions in Profile Box

What health issue/life challenge prompted you to schedule a session:

What top 3 aspects in your life do you wish to change or improve.

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Were you referred to me, if so by whom?

PROFILE *

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