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Consultation Request – FREE Mini Diagnostic Report

Baloons

Last Step:  Email us a photo of you

Your FREE Pure Energy Mini-Diagnostic Report will be completed remotely using a photo of you that includes your skin (e.g. hand, foot or face). To complete your registration for your informative, FREE Pure Energy Mini-Diagnostic Report, please:

1. Complete the form below,
2. Attach a photo of you that includes your skin (e.g. hand, foot or face), and,
3. Hit the “Send Photo” Button.

What photo is OK?

Having a photo of you helps us tune into your energy at a deeper level when completing your Diagnostic.

  • Your skin needs to be visible in the photo. It doesn’t have to be your face. It can be a photo of your hand, elbow, foot etc.
  • The age of the photo doesn’t matter. You can use any new or old photo as long as it’s you.
  • You can use a color or black/white photo.
  • Photo should NOT include skin of other people.

Upon completion of the Diagnostic, all photographs are removed and destroyed.

Don’t forget to hit the “Send Photo” button at the end.

Consultation Request Form

Your Name (required)

Your Email (required)

Subject

Please answer the following question:
1. What do you want more of in your life?

Please answer the following question:
2. What do you want less of in your life?

Photo Upload:
Please upload your photo

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