{"id":4674,"date":"2025-07-12T22:14:00","date_gmt":"2025-07-12T14:14:00","guid":{"rendered":"https:\/\/siqhealers.com\/?page_id=4674"},"modified":"2026-06-21T21:51:13","modified_gmt":"2026-06-21T13:51:13","slug":"book-consult","status":"publish","type":"page","link":"https:\/\/siqhealers.com\/en\/book-consult\/","title":{"rendered":"Book Consultation"},"content":{"rendered":"<div class='fluentform ff-inherit-theme-style fluentform_wrapper_9'><form data-form_id=\"9\" id=\"fluentform_9\" class=\"frm-fluent-form fluent_form_9 ff-el-form-top ff_form_instance_9_1 ff-form-loading ffs_inherit_theme\" data-form_instance=\"ff_form_instance_9_1\" method=\"POST\" action=\"\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Healing Consultation Intake Form - Siquijor Healers<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='4674' \/><input type=\"hidden\" id=\"_fluentform_9_fluentformnonce\" name=\"_fluentform_9_fluentformnonce\" value=\"dd94b640cb\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/4674\" \/><div id=\"form_header\" class=\"ff-el-group ff-el-section-break  ff_center\" data-name=\"section_break-9_1\" ><h3 class='ff-el-section-title'>Siquijor Healers Life Coaching Services<\/h3><div class='ff-section_break_desk'><p><strong>Healing Consultation Intake Form <\/strong><\/p>\n<p>Quick, simple, and confidential. Answer a few key questions below so we can better understand your situation before our consultation begins.<\/p><\/div><hr \/><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-9_2\" ><h1 data-pm-slice=\"1 1 []\">Online Healing consultations with Bro Eric.<\/h1>\n<p>&nbsp;<\/p>\n<ul>\n<li>\n<p>Detailed Assessment<\/p>\n<\/li>\n<li>\n<p>Personalized advice<\/p>\n<\/li>\n<li>\n<p>Free Guide for Problems<\/p>\n<\/li>\n<li>\n<p>Healing Water<\/p>\n<\/li>\n<li>\n<p>Product and service recommendations<\/p>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>PAY BEFORE CONSULTATION. 1K PER SESSION.<\/strong><\/p>\n<hr \/>\n<p>&nbsp;<\/p><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-9_3\" ><p><strong>GCASH:<\/strong><\/p>\n<ul>\n<li>John Eric V. Roxas<\/li>\n<li>09552954495<\/li>\n<\/ul>\n<p dir=\"ltr\"><strong>Metrobank:<\/strong><\/p>\n<ul>\n<li dir=\"ltr\">John Eric V. Roxas<\/li>\n<li dir=\"ltr\">9973800269416<\/li>\n<\/ul>\n<hr \/>\n<p>Please screenshot and upload the proof of payment below. Thank you.<\/p>\n<hr \/>\n<p>Bro Eric will message you to schedule a time to call.<\/p><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 70%;'><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_full_name' id='label_ff_9_full_name' >Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"full_name\" class=\"ff-el-form-control\" placeholder=\"Your Full Name\" data-name=\"full_name\" id=\"ff_9_full_name\"  aria-invalid=\"false\" aria-required=\"true\"><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 30%;'><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_age' id='label_ff_9_age' aria-label=\"Age\">Age<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"age\" id=\"ff_9_age\" class=\"ff-el-form-control\" placeholder=\"Age\" data-name=\"age\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=\"true\"><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_input_text_1' id='label_ff_9_input_text_1' aria-label=\"Facebook Name\">Facebook Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" placeholder=\"Please enter your name on Facebook and message us on Messenger.\" data-name=\"input_text_1\" id=\"ff_9_input_text_1\"  aria-invalid=\"false\" aria-required=\"true\"><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_input_text' id='label_ff_9_input_text' aria-label=\"Birthdate\">Birthdate<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" placeholder=\"Full Date of Birth MM\/DD\/YYYY\" data-name=\"input_text\" id=\"ff_9_input_text\"  aria-invalid=\"false\" aria-required=\"true\"><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_email' id='label_ff_9_email' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_9_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\"  aria-invalid=\"false\" aria-required=\"true\"><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_phone' id='label_ff_9_phone' aria-label=\"Phone\/Mobile (WhatsApp if possible)\">Phone\/Mobile (WhatsApp if possible)<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Mobile Number\" data-name=\"phone\" id=\"ff_9_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=\"true\"><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_main_concern' id='label_ff_9_main_concern' aria-label=\"Main concern or situation you wish to consult about\">Main concern or situation you wish to consult about<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_9_main_concern\" name=\"main_concern\" id=\"ff_9_main_concern\" class=\"ff-el-form-control\" placeholder=\"Briefly share your feelings or situation...\" rows=\"3\" cols=\"2\" data-name=\"main_concern\" ><\/textarea><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_duration' id='label_ff_9_duration' aria-label=\"How long has this been happening?\">How long has this been happening?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"duration\" class=\"ff-el-form-control\" placeholder=\"E.g. 2 weeks, 6 months, or several years\" data-name=\"duration\" id=\"ff_9_duration\"  aria-invalid=\"false\" aria-required=\"true\"><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_desired_outcome' id='label_ff_9_desired_outcome' aria-label=\"What do you want to happen or change after the consultation?\">What do you want to happen or change after the consultation?<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_9_desired_outcome\" name=\"desired_outcome\" id=\"ff_9_desired_outcome\" class=\"ff-el-form-control\" placeholder=\"What do you want to feel or change after the session?\" rows=\"2\" cols=\"2\" data-name=\"desired_outcome\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_image-upload_1_1' id='label_ff_9_image-upload_1_1' aria-label=\"Face Picture Upload of the Performer\">Face Picture Upload of the Performer<\/label><div class=\"ff-el-tooltip\" data-content=\"Pwede niyo upload ang mukha niyo dito para mas matawasan kayo ng mabuti\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 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class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_9_image-upload_1' id='label_ff_9_image-upload_1' aria-label=\"Proof of Payment\">Proof of Payment<\/label><div class=\"ff-el-tooltip\" data-content=\"Pakilagay ang buo at malinaw na screenshot ng proof\"><svg width=\"16\" height=\"16\" viewbox=\"0 0 25 25\"><path d=\"m329 393l0-46c0-2-1-4-2-6-2-2-4-3-7-3l-27 0 0-146c0-3-1-5-3-7-2-1-4-2-7-2l-91 0c-3 0-5 1-7 2-1 2-2 4-2 7l0 46c0 2 1 5 2 6 2 2 4 3 7 3l27 0 0 91-27 0c-3 0-5 1-7 3-1 2-2 4-2 6l0 46c0 3 1 5 2 7 2 1 4 2 7 2l128 0c3 0 5-1 7-2 1-2 2-4 2-7z m-36-256l0-46c0-2-1-4-3-6-2-2-4-3-7-3l-54 0c-3 0-5 1-7 3-2 2-3 4-3 6l0 46c0 3 1 5 3 7 2 1 4 2 7 2l54 0c3 0 5-1 7-2 2-2 3-4 3-7z m182 119c0 40-9 77-29 110-20 34-46 60-80 80-33 20-70 29-110 29-40 0-77-9-110-29-34-20-60-46-80-80-20-33-29-70-29-110 0-40 9-77 29-110 20-34 46-60 80-80 33-20 70-29 110-29 40 0 77 9 110 29 34 20 60 46 80 80 20 33 29 70 29 110z\" transform=\"scale(0.046875 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It is not a substitute for medical diagnosis, medication, or professional medical care.<\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Terms and Conditions: Naiintindihan ko at sumasang-ayon ako sa Terms and Conditions. Contains 1 link. 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