Healing Request

Please complete the fields below to request healing for yourself, then click the yellow 'Submit' button. A member of the healing team will get in touch with you as soon as possible.

You are very welcome to attend an in-person contact healing session. Services take place each Monday at 2:30pm.* On your first visit, please arrive a little earlier for a consultation with an experienced, qualified healer before receiving healing.

* (excluding Bank Holidays and closure for Christmas, Summer and Easter recess)

Date of request*

Are you aged 18 years or over?* Yes No

Note: If you are under 18, we require consent from a parent/guardian prior to offering contact or distant healing.

Title if applicable:*

First Name & Surname:*

Address: (House/Flat number, Street name, Town/City, County, Postcode)*

Email:*

Please tells us, as clearly as possible, the conditions for which you are seeking healing support:*

I hereby give consent for the data provided in this form to be confidentially processed by White Eagle Lodge.*

All information, including processing and storage, provided to our healing teams are treated as private and confidential. The details we collect from you are to assist with your healing and to communicate with you. The details you provide will only be used for this purpose.

To find out how we protect and manage your data, please refer to the full privacy notice on our website: www.white-eagle.org.uk/privacy-policy

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