Healing Information Form

Please note below information is for the person requiring healing energy from the Universe and all the divine beings.

– If you are purchasing the healing for yourself, please fill your details in.

– If you are purchasing the healing for your loved one, please fill in your loved one’s details.

The more accurate and detailed the information are provided, the better will be for the healing results.

Your Name(Required)

First Last

Your Email(Required)

Enter Email Confirm Email

Your Phone(Required)

Name whose healing this is for(Required)

First Last

Gender(Required)

Age(Required)

Please enter a number from 1 to 99.

Photo(Required)

Accepted file types: jpg, png, Max. file size: 10 MB.

Address(Required)

City Country

Time Zone(Required)

What are you/they suffering from?(Required)

(We normally recommend to focus are 2-3 areas, such as emotional and grief, headache, infertility)

How long have you/they had the condition for?(Required)

Any other special health condition or concerns?(Required)

(For kids with special condition, or if pregnant, different healing energy intensity is required)

What’s your/their ideal outcome?(Required)

Please attach any medical records or summary.

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 50 MB, Max. files: 5.

Start Healing Session On(Required)

Healing session cannot start today.