Energy Retest
Fields with an asterisk are required. All information is kept confidential.
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
Please describe in detail how you are feeling since completing the previous set of recommendations or receiving the Energy Healing. State any current concerns or conditions you are experiencing.
*
Energy Test Fee
The fee is $50 and can be paid by E-Transfer or Credit Card.
Select Payment Method
*
E-Transfer: Send to gtrimarchi@innergetics.ca
Credit Card
Credit Card Processing
*
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Energy Test
$
50.00
CAD
Total
$
0.00
CAD
Credit Card Information
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Submit
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