Spritual Healing through Casework

To participate in our Free International Spiritual Healing Service, please provide the following information for the person desiring healing assistance to the best of your ability. Please be thorough and concise. Be sure you have read and agree with the Assignment and Authorization at the bottom (this gives us legal permission to publish your health information).


Subject Identification:


Other Information:

Medical Diagnosis (if known)
Symptoms as perceived by the subject; describe all health problems and specific location, which side (left or right) etc. Use lay terminology only; no medical terminology in this section
Past Operations/Accidents (with approximate dates if known, month/year is fine)
Dominant Personality Characteristics
General Description: height (ft./in.), weight (lbs.), eye color, hair color, complexion, glasses?, smoker?, occupation
Any other Relevant Information not listed above.

Assignment and Authorization:

Do you accept the Assignment and Authorization shown below? Accepting this is equivalent to signing this document. (you must accept this agreement in order for us to accept your case)   Yes

Assignment and Authorization: I hereby authorize this website to furnish its subscribers, students of Jose Silva's healing m ethods, and/or researchers with the information contained in this Subject Information Form, for their better understanding an d development of caseworking techniques, used for the subjective detection and correction of health abnormalities. I underst and that completing and submitting this form does not guarantee a place in the database or on the website, and that healing b enefit is not guaranteed. I further understand that there is no charge for submitting a case.

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