ABSENT OR DISTANT HEALING
REQUEST FORM

Names will be held in the absent healing book for a month unless requested otherwise. Feedbacks will be much appreciated, to let me know whether or not the desired health results have been achieved.

PLEASE ENTER DETAILS OF THE PATIENT TO BE HEALED:

Patient is

Name:

Age:

Male or Female:

City or Town:

Country:

PLEASE GIVE BRIEF DETAILS OF THE PATIENT'S MEDICAL HISTORY:

ADDITIONAL DETAILS OF ANIMALS:

Species:


Breed:





Copyright © 1999.
Last Updated May 1999
For more information contact: holyheal@ozemail.com.au