Free Distance Healing - Request Form

Free Ascension Healing - Request Form

We are delighted to offer you the chance to receive 18 months of free Ascension Healing. To receive these beautiful healing energies, we kindly ask that you sign up using the form below. For more information about how to improve your healing results, you can check out our Ascension Healing FAQ's.

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Name *

First

Last

Email *

Country *

I am over the age of 16 *

Yes

Would you like to add any additional people to this free Ascension Healing service? *

Yes No

If yes, please state the names you wish to add here: *

Each person must give their permission to receive healing from Love Inspiration: *

I confirm that each recipient has given their permission

Additional Comments *