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This form is to BOOK an appointment. Filling in this form does NOT mean you have paid ! In order to pay please click on the Payment tab, and you will be lead to Paypal. If you have a Dutch bank account, then you can transfer money directly. Details about this are also on the Payment page.
Name
Telephone number:
Email address:
Interested Package :  

In Person Healing € 100
Distance Energy Healing € 100
Telephone Consultation € 65
Chakra & Hara Assessment € 75

Heal! en jezelf ook € 425
Heal! de volgende stap € 315

Preferred day(s) of the week
Preferred time of day: Morning
Noon
Afternoon
No Preference
Any other information/comments:
 

 

 
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