Perceptual Healing Journey Across America Questionnaire
I want to know what your perception is of your world.
Please fill out and submit this online survey if you would like to be heard.
_____________________________
How often do you laugh?
Never
Sometimes
Often
Are you:
Religious... attend a church regularly
and/or
Spiritual... practice meditation, kindness, yoga etc
Both
Neither
How often are you hugged?
Never
Sometimes
Often
How often do you initiate hugs?
Never
Sometimes
Often
Do you meditate?
Never
Sometimes
Often
Do you exercise?
Never
Sometimes
Often
Do you consider yourself a healthy person?
Yes
No
Do you consider yourself a loving person?
Yes
No
Have you healed from a serious illness in your life?
Yes
No
Are you interested in being part of the Perceptual Healing Journey Research and documentary ?
Yes
No
Would you like us to let you know when we are coming to your area?
Yes
No
Are you interested in having us speak to your group or business?
Yes
No
Your name
Your email address
Your phone number
Your home address
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You can now purchase the
Perceptual Healing
Chakra Meditation CD
All proceeds from the sale of this CD will be used to support Denise's Perceptual Healing: An American Journey.
To learn more about this journey into America and to order this CD for $20.00
click here
.