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Enrollment Form

Please note that I will need at least the following details from you:

All Applications

  • Your first and last name
  • Your Email address. This email address will be used as the sole means of communication, so please make sure that you provide the correct address.
  • Your telephone number. I do not call my patients and this phone number will be used only in urgent cases.

I need to keep these details for my own evidence only. They will not be disclosed to any other parties.

Before sending question, please be aware that my healing is not free. There is yearly healing fee. For details please check tab: “offer” in menu.

By filling up this form below you are acknowledging that there will be yearly fee for my healing if you choose to enroll. 

Fields marked with * are mandatory

Service I wish to enroll in:

Enrollment Form

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