Galaxy Healing World

Book Your Therapy Session

Experience personalized healing therapies tailored to your unique needs

Are you an existing client?

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Personal Information

All fields marked with * are mandatory

Full Name *

Mobile Number *

Email Address *

Date of Birth *

Enter numbers only (e.g., if your birth date is 15 June 2018, type 15062018 to automatically format as 15/06/2018).

I do not know my date of birth

Approximate Age *

Gender *

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Who is filling out this form?

Address Details

House Number/Building Name *

Street Name/Locality *

PIN Code *

District *

Circle/State *

Your Occupation *

Your Educational Qualification *

How did you learn about our service? *

Are you living with any kind of disability or medical condition? *

No Yes

Disability Details

Type of Disability *

Percentage of Disability *

Upload Disability Document * Accepted formats: PDF, JPG, JPEG, PNG

Describe Your Concern

Please briefly describe your issue or what you would like to discuss during the session.

Record Your Issue (Optional)

You can record your issue or concern (maximum 1 minute)

Note: By recording audio, you consent to store your voice recordings for therapy analysis purposes.

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By submitting this form, you certify that the provided information is accurate. You voluntarily consent to share your personal details and voice recordings for therapy purposes and agree to abide by our Terms & Conditions, Privacy Policy, and Refund & Cancellation Policy.

Payment Instructions

After clicking the (Pay and Confirm Booking) button, you will be securely redirected to the Razorpay Payment Gateway. Once your payment is successful, please wait a few moments while Razorpay verifies your transaction and automatically redirects you back to the Galaxy Healing World website.

Important: Please do not press the Back, Refresh, or Close button on your browser until the payment process is complete.

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