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Mind Body Soul Therapy with Laleh Ameri >
Online Counselling and Therapy
Mind Body Soul Therapy with Laleh Ameri
Sessions in English and Persian
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Biochemic Consultation Intake Form

Please fill in the following form to describe the issues you want to address during your Biochemic Consultation session. Biochemic Consultations are based on facial analysis as tissue salt deficiencies become visible on the face. Therefore a facial analysis is required for which you need to provide three pictures of your face, one of each profile and one full-face. All three must be close shots taken before you put on any product or make up on your face. They can be take with your mobile phone, if the resolution is high enough.
Email
Skype handle
Name & Surname
Date of Birth (mmddaaaa)
Place of Birth
How did you hear about me?
 
Upload 3 photos of your face, one of each
profile and one full face.. All need to be close shots.
Please describe the issues and symptoms you want help with as well as your general state of health and well-being.