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Healing Registration

Fill in the form below to register for a Pranic Healing session. Our team will contact you within 24 hours.

Please Note

Pranic Healing is a complementary healing modality. It does not replace conventional medical treatment. Please continue any prescribed medical treatment while receiving Pranic Healing.

Patient Information

Name of Patient *

Contact No *

Date of Birth *

Gender *

Occupation

Referred By

Medical Conditions / Current Diagnosis

Symptoms

Please describe each symptom separately. Add as many symptoms as needed.

Disclaimer & Agreement

I understand that Pranic Healing is not meant to replace conventional medicine/medical treatment but rather to complement/accelerate it. If symptoms persist, a medical doctor is to be consulted. I hereby release the person or persons or organizations providing the Pranic Healing from any liability as a result of the services received by me. I understand this testimonial shall be kept confidential, though it may be used for internal purposes.

I have read, understood and agree to the above disclaimer regarding Pranic Healing services. *

I have read and agree to all the above terms & conditions. *

Our team will contact you within 24 hours to confirm your session.