Distant Healing Request

We request a one-time donation of $100 in honor of this request. Once you fill out and submit the below form, your request will have been received. You’ll then have the option to make a donation. Thank you.

Please tell us what you’re requesting:

    Click to Select
  • Healing for Myself
  • Healing for Someone Else
  • Services for the Deceased
  • Mail-in Form

Please enter your information

Please enter your information below. We will not send confirmations to the recipient but to the requester.

Please enter the information of the healing recipient here:

Attach a recent photo (optional)

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