You are booking a healing with Alok Jariwala
First Name
Last Name
Email address
Phone number
Postcode / Eircode
ConditionA brief description of what you would like treatment for
I understand that my contact details will be passed to a Pranic Healing Therapist registered with the Institute of Pranic Healing UK & Ireland and this information will not be given to a third party. I also understand that this information will only be used in conjunction with my treatment and not for any other reason. I understand that that Pranic Healing is not meant to replace conventional medicine but rather to complement it. If symptoms persist a medical professional will be consulted immediately. I hereby release the therapist providing the Pranic Healing treatment and the Institute of Pranic Healing UK & Ireland from any liability as a result of the treatment received.
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Institute of Pranic Healing