CREATE YOUR PROFILE

CREATE YOUR PROFILE

Let’s get you matched with a healer.
PLEASE MATCH THE HEALER WITH*

MeMy Child or dependent (under age 18)A loved OneA Pet
THE GENDER OF THE PERSON BEING MATCHED WITH A HEALER IS:

FemaleMaleOther
NAME OF CLIENT BEING MATCHED*

First NameLast Name
YOUR NAME, IF DIFFERENT THAN ABOVE

First NameLast Name
YOUR EMAIL*
example@example.com
YOUR PHONE NUMBER*
Please enter a valid phone number.
HOW DO YOU PREFER TO BE CONTACTED TO SCHEDULE YOUR FREE CONSULTATION?*

Call MeText meEmail MeWhatsApp TextWhatsApp Call
CLIENT LIVES IN WHAT CITY, STATE, COUNTRY?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
WHAT SYMPTOMS CAUSES YOU TO SEEK HEALING? (Select all that apply)

Addiction to Electronics, Food, Adrenaline, Anger, Spending, Hoarding, OtherAddiction to DrugsAddiction to PornographyAnger Management, Quick to Anger, Explosive EpisodesBedwettingChildhood TraumaEmotional Pain, Grief, Broken Heart, Betrayal, OtherFeel Cursed / Generational CursesFeeling Numb, Disconnected From Self or GodGrief from loss of spouse, child, or loved oneIntegration From Plant Medicine HealingKundalini Awakening IntegrationLack of Purpose, Direction, Motivation.Mental Illness, Depression, Anxiety, BPD, PTSD, OCD, ADD, OtherPhobias, Irrational FearsPhysical Pain, Chronic Illness, Disease, Back Pain, Digestive Issues, OtherPossession / Attacks of Negative EntitiesPost Partum DepressionRelationship Healing, Communication, Insecurities, OtherRepeating Unhealthy Cycles, Self Sabotage, Self Betrayal, Self HarmStuck, Lack of Progression, Unhappy in Career, Abundance Mindset, Creating WealthUnderstanding My Own Intuitive GiftsVictim of Narcissistic Spouse or ParentVictim of Satanic RitualsVictim of Spousal Emotional or Physical AbuseOther
PLEASE SPECIFY:
Tell us a little more about your condition or situation.
HOW DID YOU FIND US?*
Referred By

First NameLast Name - if known
I AGREE, I HAVE READ AND UNDERSTAND THE DISCLOSURE

DISCLOSURE: Wellness services are provided in compliance with Chapter 629 of the NRS. It is recommended that before beginning any wellness plan you notify your primary care physician (PCP) or other licensed health care professionals (LHCP) of your intent to use wellness services and the nature of this healing. SBT Energy Therapy® modality involves balancing the Subtle Energy Body and Physical body in different aspects. Aspects include: balancing of the emotional body, energy body, physical structures, pathogens, toxicity and more. This process is designed to identify imbalances using kinesiology and correct them through transmutation, thus bringing the body back into alignment, creating homeostasis so that the innate self-healing ability of the body will take over. The result of this is, pain, discomfort and malfunction of the body often disappear, organs function as they should, energy levels are raised, and emotional issues become manageable or nonexistent. Energy Therapy is not intended to replace medical treatment of a PCP or LHCP. It is recommended that if you are taking medications, you ask your PCP or other LHCP about any potential side effects, risks or conflicts between any medications or treatments and the wellness services you intend to receive. I understand I am unable to request a healer to be matched to anyone other than myself, my dependent under the age of 18, my pet, or a person whom is incapacitated which I have legal authority over their emotional and or physical wellbeing.
PLEASE GIVE YOUR CONSENT:

I consent Laura Lopez to energetically tap into my subconscious to identify which healer is in my highest and best interest and is the best match for my healing journey.
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