Nahziryah Monastic Community - Retreat for Meditation and Holistic Living - Better Health Naturally Department


BETTER HEALTH NATURALLY INFORMATION DEPARTMENT

Alternative health care information, provided by NMC's resident herbalist under the direction of Reverend Nazirmoreh (A.B.R.D.), for you or your loved one's dis-ease. Including, but not limited to, herbal remedies, dietary concerns (body, mind and soul), nutrition, attitudinal awareness, aromatherapy, color therapy, reflexology, acupressure, breathing, movement, music, meditation, affirmations - depending on the nature of the dis-ease. A truly holistic approach to health care.


Please be aware:
The information provided by NMC's Better Health Naturally Information Dept. is supplied as a service only - to impart information and is not a prescription. For serious ailments, one should consult a concerned, licensed, Health Practioner. To complete any portion of the following form and send it in, constitutes acceptance of this release.

After completing the below questionnaire (this is a secure transmittal), your report is forthcoming. Much time, effort and research... Truth, Light and Love is put into each report. We ask a $15 contribution for all reports to be researched and compiled**, upon request, with someone in particular in mind. The contribution will assist in the continuance of our service. Credit cards accepted - enter information at end of form, thank you. Thank you for letting Nahziryah Monastic Community be of service.

**LISTING OF REPORTS PREVIOUSLY COMPILED: $7.00 each ---
Depression
Anxiety
Parkinson's
Arthritis
Thyroid Gland Disorder
Fatigue
Respiratory Problems Related to Cigarette Smoke Inhalation
Prostate Disorder

Health Questionnaire

Name (required):

Mailing Address (required):

EMAIL ADDRESS (required):

Telephone (required): Fax #:

Occupation:

Date of Birth: Birth Place:

Gender: M F Height: Weight:

Marital Status: Number of children:

Has dis-ease been diagnosed by a doctor? Yes No
If so, what was the diagnosis?

Describe Present Physical Condition, describing symptoms experienced:

Describe Present Emotional Condition:

How do you define your personality ? (Check all related.)
extrovert
introvert
tolerant
disciplinarian
emotional
sensitive
peaceful

For how long have you had this dis-ease?
Any family members having the same problem?

Hobbies and Leisure Activities:...........

Medical Treatment History:...................

Have you had any experiences of allergic reactions toward food/medicine/others. If so please give details.........

Surgery and Organs Missing:..............

Prescription Drugs Currently Used:....

Previously Prescribed Prescription Drugs:

Aspirin & Non-prescription Drugs:

Typical Meals:
Breakfast - Time Content

Lunch - Time Content

Dinner - Time Content

Nutritional Supplements (Vitamins/Minerals/Herbs/etc.):

Check box if you Smoke Tobacco: If yes, how often?

Check box if you Drink Alcohol: If yes, how frequent?

FORM OF PAYMENT (required):

AMEX

VISA

MC

DISCOVER

Card holder's name:

Card holder's daytime area code & phone number:

FOR SECURITY, PLEASE CALL THE MONASTERY (870-449-4381) WITH CREDIT CARD INFORMATION

Peace Be With You
Nahziryah Monastic Community
Nazir Order of the Purple Veil

Mail completed form to:
Rev. Nazirmoreh K. B. Kedem
Nahziryah Monastic Community
Nazir Path 970 MC 5029
Saint Joe, AR 72675

E-mail: eemeht@mtnhome.com

OR




Blessings and Thanks to our Spiritual Teacher and Director - Rev. Nazirmoreh (A.B.R.D.)...
Founder and Spiritual Head of Nahziryah Monastic Community
and the Nazir Order of the Purple Veil

Extension of Services... Collective Effort

Initiated student by and of Rev. Nazirmoreh;
Dr. Nazirahk K. K. Amen, member of Nahziryah Monastic Community and the Nazir Order of the Purple Veil.



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