Medical Body Dowsing Client Profile

 Welcome to the Medical Body Dowsing Page.

NOTE: You MUST make a payment for your "Medical Body Dowsing" session before your dowsing session can be completed. After your payment is made, come back to this page and fill out the "Client Profile" below which will then be sent back to me. I will then do your Medical Body Dowsing session and then contact you by phone to give you my "Results of Findings" 

To make a payment please click here 

 

"Client Profile"

If a topic below does not apply to you please indicate by typing in the box = "None"

 

When your form is completed click "Continue" and this same blank form will reappear.

The form you just filled out has been sent to me at yourbodycanheal@gmail.com

You DO NOT need to fill the form out again. 

* Required fields
E-mail Address *
First Name *
Last Name *
House / Business Shipping Address: *
Country & Postal Code *
Today's Date: *
Phone:( Land Line )
Cell Phone Number
Skype number:
Gender: M / F *
Age: *
Weight:
Main Complaint's *
Operations or Organs removed during your lifetime *
Do you take Prescription Medications> Yes / No. What health condition are you taking the medication for: *
Supplements you are currently taking on a daily basis:
If you are currently taking a homeopathic remedy. List remedies and potency
IMPORTANT > Are you willing to take a supplement that may contain some animal by-product in the supplement, for a short period of time ?
Other Dietary Preferences / Explain
I have Dietary Restrictions or Food Allergies:> List them below *
Additional Information Roger should know before testing you.
Your Electronic signature OR Type in your full name *


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Click any of the links below to view additional pages and services offered by

Body Expressions 

949-933-7666

yourbodycanheal@gmail.com

                " Your Body has the Answer to Your Cure" ...   Roger                        

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