Appointment Request Form
Schedule a $20 phone call with a mental health advocate. After this form is submitted & received, I will reach out to you by the phone number you provide below. I am here for you.🫶🏽 Let us know how we can help you at A Me Edition LLC.
Full Name
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First Name
Last Name
Please submit $20 payment to schedule call by scanning the QR code below or searching “A Me Edition LLC” on PAYPAL & then upload your proof of payment at the end of this form.
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I understand
Client’s $20 payment is for a scheduled phone call & a max of a 1 hour time limit. Payment must be sent at least 24 hours before appointment time or client will have to reschedule their appointment. I understand and agree to all terms and conditions.
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Yes
Contact Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
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example@example.com
What services are you interested in? Healing, Self Improvement, Or Spiritual Growth Or All 3?
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What date and time work best for you? EST
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Any other specific date and time, if the above selection is not suitable?
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Month
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Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Print Name
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First Name
Last Name
Today’s Date
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Month
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Day
Year
Date
Upload your proof of payment here(must be sent AT LEAST 24 hours BEFORE your appointment date & time or you WILL have to reschedule)
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