Healing Consultation Intake Form - Siquijor Healers

Siquijor Healers Life Coaching Services

Healing Consultation Intake Form

Quick, simple, and confidential. Answer a few key questions below so we can better understand your situation before our consultation begins.

Online Healing consultations with Bro Eric.

Detailed Assessment
Personalized advice
Free Guide for Problems
Healing Water
Product and service recommendations

PAY BEFORE CONSULTATION. 1K PER SESSION.

GCASH:

John Eric V. Roxas
09552954495

Metrobank:

John Eric V. Roxas
9973800269416

Please screenshot and upload the proof of payment below. Thank you.

Bro Eric will message you to schedule a time to call.

Name

Age

Facebook Name

Birthdate

Phone/Mobile (WhatsApp if possible)

Main concern or situation you wish to consult about

How long has this been happening?

What do you want to happen or change after the consultation?

Face Picture Upload of the Performer

Choose File

Face Picture of Target (who wants to be ritualized)

Choose File

Proof of Payment

Choose File

Note: This Healing Consultation Session is for your personal, emotional, practical, and spiritual guidance only. It is not a substitute for medical diagnosis, medication, or professional medical care.

I understand and agree to the Terms and Conditions.