Submission Form

If you or someone you know is experiencing an ailment or illness that you would like explored using a shamanic lens, please submit your story anonymously using the detailed form, and I may use your story as an example in an upcoming episode of Shamanic Healing with Vaness Henry.

Thank you for your interest, submission, and willingness to share your experience. Should you have any inquiries about this submission, please send all requests to my management team at mgmt@vanesshenry.com.

Nickname

Enter a fun nickname such as a colour, animal, or something else (have fun and be creative!) and I may reference your nickname in a future podcast episode so you know I was talking about your experience. Please do not use your real name.

First Name

Last Name

Date of Birth

Enter your (or the person in question) birth date.

MM

DD

YYYY

Birth Time

Please indicate whether this birth time is AM or PM for greater accuracy.

Hour

Minute

Second

Birth Location

Enter the nearest large city the recipient was born in, and include the state/province and country.

What is the illness or ailment in question?

Health History

Please share any significant health history you would like me to know, or anything else that you feel is important.

Disclosures

I understand that this information will be referenced for a future production of SHAMANIC HEALING BY VANESS HENRY and I am willingly sharing my story anonymously to be used in a future episode.

YES, I CONSENT

I understand that Vaness Henry is not a medical doctor and that any information shared is not a substitute for sound quality medical advice but meant to expand my understanding of illness on an evolved system. I understand that Vaness Henry is promoting complementary medicines to support classic, traditional and alternative medicines available at this time.

YES, I UNDERSTAND

I understand that there is no guarantee my submission will be referenced publicly.

YES, I UNDERSTAND