- in recognition that matter is energy and that
many higher levels of energy exist in reality.

By changing energy, miracles occur.


Required by State of California Legal Disclaimer
& Entrance Questionnaire, Version 2.2

Dear Recipient of Energy Reality Services,

The State of California requires that alternative practitioners give the following disclaimer in order to practice legally in the State of California. According to state law the following information must be disclosed to you. Please read, and respond entering your name and contact information where indicated below. Your response will be equivalent to a signed agreement.

Then, fill out the following Entrance Questionnaire. And the press SEND.

A copy of this will be sent to you. Thank you.

Type your name here which is designated as equivalent to your signature:
(entire name, required for services)
Today's
Date: (required for services)
Type your email address here (required):
Type your current contact information here so you may be contacted:

------------------------------------------------------------


ENTRANCE QUESTIONNAIRE:

(CONFIDENTIAL)


Please answer the following questions so there is more time in the session for healing, etc.


Due to the high demand for rapid (typically in minutes or seconds) spiritual healing of psychological issues and physical ailments, preference is given 1st to those with the severest conditions (life vs. death, intense pain, or other severe condition) and preference is given 2nd to those that can pay the most. This is because I have a waiting list of people with severe conditions but no or little money and if I served them only I would not be able to pay for my operating expenses and unable to help them at all. I allot as much time as I can to those with severe conditions, a portion to those that pay the most, and a portion to those that can only pay moderately. I try to be fair to all and put those in each category on a waiting list if necessary.
Please rate the severity of your condition on a scale of 0 to 10(being the severest):
Please describe briefly your condition or what you want to work on:

Please describe your ability to pay, per hour session, on a sliding scale of from $100(low income and no savings/assets) to $500(high income and/or high savings/assets):
(Please note: less than 48 hours notice of cancellation will incur a charge of your rate, except in case of emergencies.)
If you cannot pay anything or very little and are requesting charity please indicate this and how much you can pay:
If your are able and want to pay more than the above top rate, so that more people can be healed, please indicate what this will be:

Thank you. And, I very much look forward to helping you.
Healing Light,
Steven Lumiere

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