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Hello beautiful, let's begin your healing
This application will help determine the best plan for Pranic Healing protocols for you, also its a way for me to feel out if we’re the right fit for each other!
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Your Full Name
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Your answer
Email
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Your answer
Phone number
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Your answer
Current occupation
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Your answer
Age
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Your answer
Current condition and/or symptoms. Please rate each symptom on a scale of 1-10, with 10 being the worst.
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Your answer
Have you had any serious emotional problems (requiring medicine/therapy) in the past
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Your answer
Do you currently have any psychological or mental issues, such as fears, phobias, addictions, grief, traumas, etc.
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Your answer
Check any of the below that applies to you
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High Stress & Overwhelm
Negative Self Talk
Anger & Resentment
Feel unworthy of good health
My problem runs in family
Its not safe to get well
Guilt and feeling selfish to prioritize myself
My suffering is God's punishment
Trouble forgiving self and others
Trouble expressing my thoughts at home/work
crying alone
Low self confidence/self esteem
Anything else about your situation that you think is important:
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Your answer
Please list on a separate line all current diagnosis, current prescriptions or treatments for each.
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Your answer
Are you willing to implement quick energetic practices/ meditation into your day?
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Yes
No
Payment (
https://www.paypal.me/harithachiluka
) *(Single session @$177, 4sessions@ $666)
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Your answer
Declaration
Pranic healing is NOT a replacement for current medical system. It's a COMPLEMENTARY therapy. (Submitting this form will mean that you agree with the above declaration)
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