Registration House Cleansing – Roots Holistic Therapy

Registration Spiritual House/Business Cleansing

Your Request Is For

House

Place Of Business

First- and Last Name

What Is Your Age?

Address

Zipcode

City

E-mailadress:

Tel.nr.: (optioneel)

Mobile Telephonenumber:

How Many Square Feet Is Your House Or Building?

How Many Rooms Does Your House/ Building Have?

How Long Have You Experienced A Disbalance In The Space?

In What Manner Is this Reflected?

Please Explain The Disbalance That You Are Experiencing (optioneel)

Is There Any Additional Information That You Would Like To Share About The Space? (optioneel)

Is There Any Vermin In The Space? (mice, cockroaches,rodents etc.)

Ja

Nee

Is Your Space Clean?

Ja

Nee

Choice Of Payment

Tikkie

Pin

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