REGISTRATION FORM – VIDEO CALL RUQYAH (International)

📝 REGISTRATION FORM – VIDEO CALL RUQYAH (International)

With Ruqyah Aswaja Ustadz Dhomiruddin – Asma’ Al-Hirzi Method

If you would like to participate in distance ruqyah (via video call), please fill in the following form:

📌 Full Name:

(Write as: Name son/daughter of Father’s name)

📌 Short Address & Country:

(Example: Jakarta – Indonesia / Kuala Lumpur – Malaysia)

📌 Choose Type of Ruqyah:

🔘 General (minimum 3 participants, conducted together)

🔘 VIP (private & exclusive, flexible schedule)

📌 Preferred Day & Time (Your Local Time Zone):

⏰ Only required if choosing VIP

(Leave blank if choosing General – schedule will be set by the ruqyah practitioner)

💬 Additional Notes:

✔️ No spirits, no talismans, no physical contact

✔️ Purely Qur’anic recitation and authentic supplications

✔️ Suitable for cases of jinn disturbances, black magic, witchcraft, whispers, trauma, and more

✔️ Islamic spiritual therapy based on Ahlussunnah wal Jama’ah

📞 After completing the form, please send it via WhatsApp to Ustadz Dhomiruddin:

+62 822 4141 0610 (Indonesia)

or

+60 1071 07562 (Malaysia)