with Rebbetzin Chana Bracha Siegelbaum
Registration Form

Shalom!

Thank you for choosing to register for a private EmunaHealing session, and actively seeking to improve your physical, emotional and spiritual health. I look forward to getting to know you and to helping you, B"H.

I'd appreciate if you share with me some brief details about yourself. Please know that privacy is of up-most importance; you have my assurance that your name and personal details will never be shared with anyone without your prior consent.

After we receive this form from you, someone from my staff will be in personal e-mail contact with you to schedule our appointment. She will also follow up on all the questions you might have about EmunaHealing private sessions, including all logistical and payment information.

With blessings of the Torah & the Land,
Rebbetzin Chana Bracha Siegelbaum
________________________________________
email: director@berotbatayin.org
web: http://rebbetzinchanabracha.blogspot.co.il/2012/06/emunahealing.html

Please complete: