Holistic Therapy Treatment Online Request Form

If this is an emergency then it would be faster to use the Phone Treatment Method.

  I charge a fee of $90 NZ (Approx $66.50 US) per treatment. This includes remedies and time upto 1 hour.

All fields marked * are required to be filled in. 

*Before Ordering a Therapy Treatment you must agree to the Terms and Conditions*

 

* ‘I have read, understood and agree to the Terms and Conditions’

 

Your Contact Details

*Full Name:
*Full Address 
Please include postcode/zipcode & State (province):
*Country:
*Email Address: 
I may need to ask for further information.
*Phone Number:

Fax Number (if available please supply):

Your Animals Symptoms


Your Animals Name or Herd ID:
Animals - Type & Breed:
(eg. Dog: Greyhound, Cat: Siamese, Bird: Budgy etc.)
Animals Age:
Animals Sex:
Animals Symptoms:
( Please give a detailed description)
Has your animal been seen by a vet?:
If Yes what was the diagnosis?:
Is your Animal Eating?:
What kind of food does it eat?:
Is your Animal Drinking?
Your Animals Health history :
Is this an Acute condition?:
(Serious or sudden condition, endangering animal)
Is this a Chronic condition? 
(Developing over a long period of time):

 

REFUND POLICY

Due to the nature of my work I am unable to offer refunds for Healing Treatments.

CANCELLATION POLICY

I will attune to your animal and if I cannot help with a treatment will refund the treatment fee to your Credit Card or Paypal account (less the 2.9%+30c fee that they charge me). If this is the case I will send you an email to this effect.  

* Checking this box is an Acceptance of the above conditions of service: