ENERGETIC HEALTH PROFILE

This Report is not medically oriented, but energetic. The 4-page report includes a graph page that lists the major risks to your system, another that shows stresses to your system, another that shows your specific emotions and whether they are running high or low, and another page that shows your stresses on an environmental, physical, mental, social and spiritual level. Then we need to have a box to check to give permission to run the report. It should be the same form of agreement that we have used from the Distance Healilng Site.

First Name:
Last Name:
Street Address:
City:  
State:  
Zip Code:  
County:
Home and/or cell Phone:
FAX:
E-Mail:
Credit Card Type:
Credit Card Number:
Expiration Date:
Billing Address for Credit Card:  
   
 

 

 

DISCLAIMER: None of the above is meant to diagnose, treat, prescribe or claim to cure any disease. Clients are advised that they should consult their own medical practitioners and medical professionals for the diagnoses, care, treatment or cure of any health condition.