Appointment Request Form
Let us know how we can help you! The appointment will be ONLY be confirm after you have communicated with Dr. Karina and you both have agreed on a date.
Full Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What date and time work best for you?
Any other specific date and time, if the above selection is not suitable.
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
What services are you interested in?
*
Please specify if you are interested in a 1. myofascial release session, 2. virtual energy clearing + chakra assessment 3. intuitive reading + guidance 4. spirit baby reading 5. virtual intuitive health reading 6. intuitive guidance + coaching
Would you like to be added to our Monday's Healing Circle Newsletter?
Yes
No
Submit
Should be Empty: