Please submit form and allow 24 hours for your 1st healing request to be completed, and an email communication reply.
Thank you! Your 2nd healing will not have an email reply.
|First Name *|
|Last Name *|
|Your energy healing request is: *|
|Street Address 1 *||
|Street Address 2||
|Postal Code *||
|Card Type *|
|Card Number *||
|Expiration Month *|
|Expiration Year *|
|Start Month (if avail)|
|Start Date Year (if avail)|
|Maestro Issue Number (if avail)||
For Spiritual Healings, I give permission to the Deja Vu Hotline and Divine Healing Center to give me a spiritual healing. I understand that this is a spiritual healing and is an intangible spiritual benefit, that the healer works with my healing guides and they do the healing work. The Hotline healing staff only facilitates my healing and I agree to indemnify the staff, healing hotline and Church of Divine Man. I am of sound mind and body and understand what I'm agreeing to.
|I have read and understand the terms of this agreement.|
|(Enter your initials)|