Past client reading order form

Thank you for providing this information which will help me to prepare for our session together. Please fill out as many fields as possible - the fields marked with an asterisk are required. There is lots of room for you to include as much or as little detail as you like.

First and last name *

Email address *

Any details or background,, or questions you would like to discuss (give as much or as little information as you would like)

Please provide dates that are relevant to your question or issues, such as when a problem began or reached a crisis point

If you have paid for a relationship reading, please provide the name and birth data for additional charts as well as (1) date you met, (2) date relationship began if different, (3) dates of any problems or issues or any concerns

If you have not paid for a relationship reading but would like to discuss another person during your session please enter their birth data here.

Current location

If this is a birthday reading, please provide the place(s) where you plan to spend your birthday

Read the fine print *

I understand that sometimes technology fails and in the event I am unable to receive a sound file of the session 20% of the cost will be refunded to me. I understand that same day cancellations may not be refunded. I understand that if I am not happy with my session I will receive a full refund as long as I end the session BEFORE it is over. I understand that my appointment time will not be confirmed until payment is made.

Did you read the fine print?

Yes

Please indicate your preference for our meeting.

Long distance sessions can be done by video chat, audio chat, Skype or telephone. I prefer the web-based (Zoom meetings) video & audio chats because of the quality of the audio, but they require a web browser with microphone on a computer or a smartphone.

If you select a telephone meeting, I will call you for the session.

If you like Skype that is another option. I do prefer Zoom because of the higher quality video which is better for recording.

How do I contact you for the session? *

Zoom chat (webcam required) Telephone Skype video My home office outside of Chapel Hill NC (not currently possible) Skype audio

Phone Number

Area Code Phone Number

Phone Number

Area Code Phone Number

Can I text you at this number for emergencies? *

What is your time zone? *

Anything else you would like me to know?