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Auric Healing Online - Contact Form

Client Contact Form

Charges

Healing Charges
Rs.300/- (US$ 15) per session

Scanning Charges
Rs. 1500/- (US$ 35)

For Payment Bank details -

Anita Singh

Bank : AXIS Bank Ltd.
Account No.  :   053010100474085
Branch Code : 053
SWIFT Code : AXISINBB000053
IFSC code  :  UTIB0000053

Name of Patient : *
Age : *
Sex : *
Address : *
Pin No. : *
State : *
Country : *
Contact No. : *
Fax :
Email ID : *
Patient Photo : *

* Not more than 2MB
* Only Passport size Photograph
* Only .jpg, .jpeg, .gif, .png file types are allowed

Ailments / Disease : *
 
Security Code :
Declaration :
I have read and understood all the information regarding Pranic Distant Healing. I hereby release healers of aurahealingcenter.com from all damages whatsoever & waive all rights to compensation in case of injury.