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Personalized Body Dowsing  / Client Profile

 Welcome to the "Personalized Body Dowsing" Page.

 NOTE:  Unless you made special arrangements with Roger for payment. You MUST first make a payment for your "Personalized Body Dowsing" session before your Personalized Body Dowsing session can be processed.

 To make a payment within the United States Only, please click here

 International Payments cannot be made on this website page. Please call  Roger at 1-808-855-8272 to make a payment, over the phone.

 You can E-mail Roger atyourbodycanheal@gmail.com to arrange a payment type.

After your payment is completed.

       Return to this page and fill out the "Client Profile" below. Upon completion of the "Client Profile"  Please click "Submit Form" Your submitted form will go back to Roger. 

 Roger, can then do your "Body Dowsing" evaluation. When completed, Roger will then contact you by phone or email, to go over your "Results of the Dowsing Session" @ No extra charge.

Client Profile

Direction for filling out this form

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


When your form is completed click "Submit Form"

After you click on "Submit Form"   (You may get an error message that reads) 

"The SPAM Prevention Validation Failed."

                    Ignore that message

Please scroll back down to the "Submit Form" button

then click it again.  I will then get your "Client Profile"


NOTE The same blank form will reappear on your screen.

DO NOT fill it out again.


Your "Client Profile" has been received at the Body Expressions office.

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

You DO NOT need to fill this form out again when it reappears.

* Required fields
E-mail Address *
First Name *
Last Name *
House / Business Street Address: *
Town / City / Area *
U.S.A. State *
Country / Provience *
Zip Code / 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? 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 ?
Dietary Preferences: Please check boxes below if you DO EAT these foods? If NOT, leave blank.
Other Dietary Preferences / Explain
I have Dietary Restrictions or Food Allergies:> List them below *
Have you been vaccinated for Covid 19? If so, what Type of Vaccination: Modena, Pfizer, Johnson & Johnson? *
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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