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Personalized Body Dowsing  / Client Profile

 Welcome to the "Personalized Body Dowsing" Page.

 NOTE: You MUST make a payment for your "Personalized Body Dowsing" session before your Personalized Body Dowsing session can be completed.

 To make a payment within the USA only please click here

 NOTE: International Payments cannot be made on this website. You must call or        e-mail Roger at 1-808-855-8272 to make a payment over the phone.

 E-mail Roger at: yourbodycanheal@gmail.com to make a payment.

NOTE: If you have already made a payment please continue and fill out the "Client Profile" below.

After your payment is completed.

       Return to this page and fill out the "Client Profile" below which will then be submitted back to Roger. 

  I will then complete your "Personalized Body Dowsing" session. 

I will then contact you by phone to give you the "Results of Findings" 


Client Profile

Please fill out this client profile. 

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


When your form is completed click "Submit Form". This same blank form will reappear.

No Worries! The form you just filled out has been sent to me at yourbodycanheal@gmail.com

You DO NOT need to fill this form out again. 

* Required fields
E-mail Address *
First Name *
Last Name *
House / Business Street Address: *
Town / City / Area *
U.S.A. State
Country *
Zip Code / Postal Code
Today's Date: *
Phone:( Land Line )
Cell Phone Number
Skype number:
Gender: M / F *
Age: *
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 ?
Check Box if you DO EAT these foods below ?
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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Body Expressions 



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

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