Request a Healing

EmailMeForm

Request a Healing

Please fill up this form with your details to get distance healing.
Please do not submit multiple forms, as your requests will be taken into consideration even with just one form submission

• Full Name *
  
  

  Enter your full name with second name
• Date of Birth *
  MM / DD / YYYY
  

  Please enter you birth date and year correctly
• Place of Birth *
  
  

  Please write in format (City, State, Nationality)
• Time of Birth *
  HH : MM AM PM AM/PM
  

  Please enter time of birth, if not sure write approx value.
• Upload your current photograph
  (photograph should be without sunglasses and face should be clearly visible) *
  
  

  Please attach the current picture, if not available then add the most recent pic and mention below how old is the photograph.
• How old is the uploaded pic.
  
  

  if the photograph is not current, then please mention how old it is (10 days old or 2 months old.)
• Please describe your health problem in detail *
  
  

  Please describe your health problem,
  mention if you are under any medication,
  Also include for how much duration you are suffering from this issue,
  Any surgeries that might have been made for it,
  What else you do you feel about your problem, life
  Any other symptoms that you want to specify

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