Please make sure you fill out all of the fields below before you send your form.
Missing information will result in the loss of your request.
Enter your full name:
Enter your email address:
Enter your full birthdate (MM/DD/YYYY):
Enter the city and state where you currently live (if outside USA, enter city and country):
Please state your healing request:
DISCLAIMER: By checking the box below, I certify that: (a) I am 18 years old or older. (b) I understand that this service is completely without charge. (c) I understand that the service offered (spiritual healing) should not replace care from any medical, legal or other licensed practitioner. I understand that I may receive occasional e-mails from Rev. Jeff regarding website updates and/or special offers. I understand that my privacy is protected and my personal information will never be sold, rented or given out to anyone. I understand that I can stop receiving periodic e-mails by simply replying to the message with "unsubscribe" in the Subject line.