Sponsored Healing Request Form

Sponsored Healing Request (healing for others)

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

Please note: You must have obtained consent from the person who wishes to receive distant healing.

(*required field)

Sponsor's first name*

Sponsor's last name*

Email*

Address Line 1*

Address Line 2

Address Line 3

Town/city*

County/state*

Country*

You must obtain the patient's consent prior to receiving healing. Please confirm that they wish to receive this healing.*

Patient's first name*

Patient's last name*

Email*

Male
Female
Prefer not to say

Year of birth (approx.)

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 the patient’s symptoms are so we can give the most appropriate treatment (max. 1,000 characters).*

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.

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.