Please fill out this Spiritual Health Record. When you finish and submit it you will be taken to the appropriate room. If you are ready you will be taken right to the treatment room. Otherwise you will be taken to the Check Up room for a further examination.
If you would like to order a FREE copy of our DVD "WARNING World Wide Pandemic" please also fill out the address information and we will get one out to you as soon as possible. Check the box requesting the FREE DVD.
Also, if you would like us to send you other literature that will help you obtain and maintain spiritual health please check the box below requesting literature.
The following questions will help determine your current spiritual health condition and help prepare you for future treatment as well as a prescription to prevent further spiritual health complications. Please answer them honestly.
Thank you for filling out this Spiritual Health form. Please submit the form and you will automatically directed to the appropriate room at our Spiritual Health Clinic.