Booking Form


Name *

Sex *

MaleFemale

Date of Birth *

Address *

Mobile Phone *

Home Phone

Work Phone

Occupation *

Email *

Current medications

Recent illness

Operations

NoYes

Pregnancy

NoYes

Do you smoke?

NoYes

Alcohol intake

What area in your health would you like to improve? Or anything else I need to be informed of? *

Preferred session

In Person (Sydney Australia)Distance healing (Phone)

*I have read and accept the “Confidentiality”. Yes
*Would you be interested in joining our mailing list?
YesNo

SESSION FEES
Energetic Healing One-hour session: A$110.00
Energetic Healing One and half-hour session: A$143.00
Distance healing session: A$143.00
CONTACT NUMBER
international: +61 402034145
from Australia: 0402 034 145
Email: trueself4truehealth@gmail.com