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.

  After your payment is made, come back to this page and fill out the "Client Profile" below which will be sent to me. I will then do your "Personalized Body Dowsing" session.

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

To make a payment please click here

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

"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" and 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 the 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: *

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 ?

Dietary Preferences: Please check the boxes below that apply> Yes or No

Check Box if you DO EAT these foods below ?

Red meat

Turkey - Chicken >

Pork >

Fish >

Eggs >

Dairy Products >

Vegan Diet - I only consumes plant-based foods

I eat a Gluten Free Diet >

I eat a Macrobiotic Diet >

I am willing to change my diet if needed.>

Other Dietary Preferences / Explain

I have Dietary Restrictions or Food Allergies:> List them below *

Additional Information Roger should know before testing you.

I understand that Roger Denisewicz is NOT a medical doctor or a substitute for medical advice. I also understand Roger does not diagnose, treat or cure disease and uses historically known foods and herbs to balance the human body. *

I give permission for Roger to evaluate what my body wants and needs for optimal health. *

Your Electronic signature OR Type in your full name *

I have read and agree to the Privacy Policy *

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