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ABOUT US
YUMIKO ASAKURA
Back
IN-PERSOON SESSION
DISTANT HEALING
ABOUT
ABOUT US
YUMIKO ASAKURA
COURSES
SESSION
IN-PERSOON SESSION
DISTANT HEALING
LEAVES INSTITUTE
EVENTS
BLOG
CONTACT
日本語
Distant healing booking form
Please complete the form below
Your Name
*
First Name
Last Name
Email
*
Date of Birth
Address
*
If the recipient is different from above, please write their 1.Name, 2. Date of Birth, 3.Address 4.She/he agree to receive healing
What would you like to be focused in the distant healing?
*
Date (at least 48h in advane of the payment receipt/Except weekends and public holidays). There are very occasionally unable to allocate your date/time if so we will contact you with alternative.
*
MM
DD
YYYY
Time
*
Hour
Minute
Second
AM
PM
Where did you hear about us?
Thank you!