Personal Healing Request Form

Personal Distant Healing Request

Once you have completed the online healing request form below, please click submit

(*required field)

First name*

Last name*

Title if applicable*

Year of birth

Email*

Address Line 1*

Address Line 2

Address Line 3

Town/city*

County/state*

Postcode/zip code*

Country*

Please tell us, as clearly as possible, what you would like healing for, so we can give you the most appropriate treatment.*

Privacy notice: This form collects details required by the White Eagle Lodge in order to communicate and assist you. Your details will only be used for this purpose. Please check our Privacy Policy to see how we protect and manage your submitted data.

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.

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Healing donations

We do not charge for healing. However, if you’d like to make a donation towards our administration costs, this would be much appreciated. Any contribution you make will help us continue this special work. We thank you.