Appointment Request
Please complete this form after you receive a payment confirmation.
Please enter your payment confirmation number. *
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Which service did you purchase today? *
Who is the service for? *
Are you 18 years or older? *
In order to perform the Akashic Records Consultation, Life Coaching or Numerology Report, we need the following information to access the specific record in question: What is your current full name, full name at birth, date of birth and place of birth? *
(If this does not apply to the service purchased, place N/A below)
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IF YOU PURCHASED THE PROPERTY CLEARING SERVICE: Please provide full address of property. (If this does not apply to the service purchased, place N/A below) *
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I understand the results are intended for the individual receiving the service. I understand all services will be kept confidential and I am fully responsible for sharing information only intended for me to receive. *
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What is the best phone number to reach you if necessary? *
(xxx) xxx-xxxx
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How did you hear of our services? *
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