Heal Transform Evolve
Biophilia BioResonance Biofeedback Therapy & Spooky2 Frequency Healing
Name
First Name
Last Name
The address will be used if you request a remedy or a holographic sticker be made from your Metatherapy scan and mailed to you.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
As part of the scan, I will need your blood type. Please check the one that applies to you.
O Blood Type
A Blood Type
AB Blood Type
B Blood Type
Birth Date
Current health struggles or diagnosis. List 5 in order of importance.
If you do not have a specific diagnosis, what area would you like to focus on? Digestive System? Cardiovascular System? Urinary System? Lymphatic System? Musculoskeletal System? Nervous System? Reproductive System? You can also indicate a specific organ or limb or bone, etc. Let's keep it to 5 areas of the body.
What are your specific symptoms? Pain? Sleeplessness? Bloating? Parasites? Be as thorough as you like.
Signature
Submit
Submit
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