Energia Positiva Jenny Scordamaglia

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LET YOUR LIGHT SHINE BRIGHT

In person Energy Cleansing Therapy - Tulum

Name

Email

Age

Selfie

Face photo no glasses

Why do you feel you need an energy cleansing?

If in a relationship how long ago

Do you suffer from any heart related problem ?

Are you a Veteran ?

yes

no

Select the ones that apply to you

Heaviness

Feeling lost

Everything comes out wrong

Depression, Anxiety

Ptsd

Suicidal thoughts

Drug,Alcohol or Porn Addiction

I have a health problem

I just want to learn Tantra

Want to attract Love

Bipolar

Everything is good except Money

Sexual Distancing from partner

Pool Mental Health

Schizophrenia

Pain at penetration (women)

Anything else you want to add ?

Will you be staying at our location ?

yes

no

Couples

lost your pleasure/spark

Loss of pleasure in woman

Swingers

New Field:

Thank you for your application

We will get back to you with a date and time for your appointment.

Energy Tulum

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Contact

E-mail: info@misionenergia.com

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