Contact Healing Request

Please complete the fields below to request healing for yourself, then click the yellow 'Submit' button. A member of the healing team will get in touch with you as soon as possible. You only need to fill in this form once, before your first visit.

You are very welcome to attend an in-person contact healing session. Services take place at New Lands each Monday at 2:30pm.* On your first visit, please arrive by 2pm for a consultation with an experienced, qualified healer before receiving healing. Some regional centres also offer contact healing. Please email us for further details.

* (excluding Bank Holidays and closure for Christmas, Summer and Easter recess)

Date of request*

Are you aged 18 years or over?* Yes No

Note: If you are under 18, we require consent from a parent/guardian prior to offering contact or distant healing.

Title if applicable:*

First Name & Surname:*

Address: (House/Flat number, Street name, Town/City, County, Postcode)*

Email:*

Please indicate briefly the conditions for which you are seeking healing support. There is no need to go into detail or disclose anything that you prefer to keep confidential. A fully qualified and experienced White Eagle healer will complete an individual and confidential registration form with you in person.*

I hereby give consent for the data provided in this form to be confidentially processed by White Eagle Lodge.*

Privacy Notice: This form collects details required by the White Eagle Lodge in order to communicate and assist you. Your details will only be used for this purpose. Please check our Privacy Policy to see how we protect and manage your submitted data.

All information, including processing and storage, provided to our healing teams are treated as private and confidential. The details we collect from you are to assist with your healing and to communicate with you. The details you provide will only be used for this purpose.

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