Agreement Philippines

Patrick Hamouy - Cured himself of liver and large intestines cancers diagnosed in July 1991. Author of several books on how to recover health using the power of foods & herbs. Patrick has helped thousands recover well-being through his internet health consultations, and lectures.

Laurence Cacteng is a gifted Filipino Psychic Surgeon. He is documented as having cured 10,000s patients over his long career. Laurence channels Jesus. Through Patrick, he offers treatments at his healing centre in the Philippines.

Please be kind enough to fill the form below so we can serve you better.

Your Group Trip to the Philippines is Booked

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

Gender*

Year of birth*

Your weight in kgs

Your height in cms

Email address*

City*

Country*

Cell Phone Number including country code*

Specify which to use to contact you + your id: Skype, FaceBook, WhatsApp, Viber or Messenger*

Next of kin name, phone number and email address to contact in case of emergency:*

If sharing a room, full name of your partner. He/she must fill another form if he/she wants a consultation

Day & Time of arrival in Manila*

Return Flight Date & Time*

If you intends to join my lectures (you must speak good English) please explain your health problems. This will be used by Patrick to help you.*

What medication(s) are you taking?*

What vitamins/ herbs are you taking?*

Do you exercise? Which and how often?*

How much stress do you have daily?*

	1 - Very little
	2 - A bit but manageable
	3 - Quite a bit
	4 - A lot
	5 - Very stressed every day

How many cups of coffee do you drink every day>*

	None
	1
	2
	3
	4
	5 or more

Do you eat any organic foods? Which and how often?*

I eat at least 3 vegetables daily for lunch and dinner*

	True
	False

I eat chicken*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

I eat pork*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

I eat beef

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

Other meat I eat:*

I eat eggs*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

I eat fish or other sea food*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

I eat dairy products from cow, goat, sheep, (butter, yoghurt)etc..*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

I eat gluten products such as bread or cakes or biscuits or floury products (i.e. pasta..) or wheat food *

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

How often do you eat seeds, nuts, avocados, hummus, coconut flesh or milk, or other oily products?*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

I use oil for frying or in salad*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

I eat tropical fruits (oranges, bananas, kiwi, mangoes, etc..)*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

How many times a week do you eat cakes, refined sugar (all colours), chocolate, sweets, other sweetened products?*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

I eat tin food or pre-prepared meals*

	True
	False

I always check labels to make sure I don't eat any harmful chemicals (additives, coloring, sugar, etc..)*

	True
	False

If you have changed your diet in the past 12 months to the above. Please state when you changed it, and what your previous diet was before.*

I drink alcohol*

	6 or more times a week
	3 to 5 times a week
	1 to 2 times a week
	Never

I smoke*

	True
	False

Other comments

How did you hear about our trips?*

Confirm your acceptance of our Agreement at www.therapies.com/agreement.html on behalf of ALL travelers*

I/we have read it and I/We agree to its terms