Agreement Philippines

Psychic Surgeon Laurence Cacteng is a gifted Filipino. He is documented as having cured 10,000s patients over his long career. Laurence channels Jesus.

Through Patrick Laurence offers treatments at his healing centre in the Philippines. Contact us, and we'll let you know if we can help.

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 call you*

	WhatsApp
	Messenger
	Viber
	I don't have any of those

Your id for the above including country code if needed

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

If sharing a room, full name of your partner

Day & Time of arrival in Manila*

Return Flight Date & Time*

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

If you intend to avail of my consultation please let me know of your disease(s) here. If you were diagnosed less than 2 years ago, please fill the rest of this form to tell me what your diet was like 2+ years ago*

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

	None
	1
	2
	3
	4
	5 or more

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

Dis you eat at least 3 vegetables daily for lunch and dinner*

	True
	False

I ate chicken*

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

I ate pork*

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

I ate beef

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

Other meat I used to eat:*

I ate eggs*

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

I ate 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 ate 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 ate 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 did 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 used 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 ate 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 did 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 ate tin food or pre-prepared meals*

	True
	False

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

	True
	False

I used to drink alcohol over 2 years ago

	True
	False

I still drink alcohol*

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

I used to smoke over 2 years ago*

	True
	False

I still smoke

	True
	False

If you have only changed your diet less than 2 years ago, please state when you modified it, and what changes you made*

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

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