Metaphysical Health Analysis Order Form 
Please enter your birth information below and describe your health issue to the best of your ability. Once completed, follow the link for payment. Your report will be emailed to you within 48 hours. Thank you!
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What is your full name?
What is your email address?
What is your date of birth? (dd/mm/yyyy)
Where were you born? (city, state, country)
What exact time were you born at? (00:00 am/pm)
Please describe in full detail the health issue you are experiencing.
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