Residential Distance Clearing & Healing Emergency Request Form Name of person ordering: Date Is this location a: Single family home Multiple family home Townhouse Apartment Houseboat Mobile home Land only Office or Place of Business What is the approximate square footage? 500 sq. ft. or less 501-1,000 sq. ft. 1,001-1,500 sq. ft. 1,501-2,500 sq. ft. 2,501-3,501 sq. ft 3,501-5,000 sq. ft. 5,001-7,500 sq. ft. 7,501-10,000 sq. ft. 10,001+ sq. ft. If this is for land, how many acres? If an apartment, is it attached to a home or in a building? If in a building, how many floors and units are there? Number of rooms and floors in your home or apartment unit? Lastly, besides plants/trees/fauna—do you share the space with any other living beings (people or pets?) Address of service inquiry request: City State ZIP/Postal Code Country We won't be contacting you there, or sharing this information. Got it! On a scale of 1-10... 1 being worst, 10 being best, please rate present state of requested space 1—worst2345678910—best Is this time sensitive? Yes No If time sensitive, please describe parameters: Reason(s) for requesting this type of Distance Clearing & Healing? How long has this been happening? What expectations do you have in regards to the Residential Distance Clearing & Healing? Anything else you would you like to share from your heart about this that you feel is important for Laura to know? Thank you. Upon submission, your form moves directly to Laura for review. If she has any questions we will be in touch with you! Please include your email below I consent to having my data collected & stored. Yes Send
