Stephen Turoff

Mr. Turoff will send absent healing to the requested person for a period of one or two months. It can be prolonged on the request of the patient.
Please attach a photograph and write a brief history of the disease of the person in question.

• 1 month ……………… 65 EUR
• 2 month …………… 120 EUR

PATIENT’S DATA:

Name and surname: …………………………………………………………………………

Date of birth: …………………………..

Street: ………………………………………………. Post code:……………………………

Town and state: ……………………………………..

Telephone: ……………………………………………. E-mail:……………………………….

Description of the disease: ……………………………………………………………………

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APPLICANT INFORMATION:

Name and surname: …………………………. Date of birth: …………………………..

Street: ………………………………………………. Post code:……………………………

Town and state: ……………………………………..

Telephone: ……………………………………………. E-mail:……………………………….

METHOD OF PAYMENT:

Donation transfer information:

Agreement: *

* I hereby agree to accept the healing freely and at my own risk. I am aware of the fact that Stephen Turoff is not a doctor and that his healing is complementary, not alternative!

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Electronic applications – Distant Healing

Please, enter your information: *(denotes required field) First Name: * Last Name: * E-Mail Address: * Date of birth: * Street: * Post code and Town: * Telephone: * Subject: Description of the disease: * A brief description of your disease symptoms or medical diagnosis Have you ever had therapy? YES NO Add your Photo: Acceptable file types: doc,pdf,txt,gif,jpg,jpeg,png. Maximum file size: 1mb. CAPTCHA Code: *