Initiate a Personal Ancestral Purpose Reading

Name *

Full Mailing Address *

Email Address *

Phone Number *

Primary

Referred By *

Date, Time and Place of Birth *

Occupation *

Marital Status *

Single

Married

Widowed

Other

Spouse's/Partner's Name *

Children - please provide names and ages

Mother's name, age or if deceased cause of passing, list previous partners or marriages *

Father's name, age or if deceased cause of passing, list previous partners or marriages *

Siblings (born alive, still-born, miscarriages, step/half siblings, adopted siblings, etc.) *

What do you wish to learn from your Ancestral Purpose Reading? *

Have you experienced therapy before? Please share when, for how long and what modality. *

Was previous therapy helpful? *

What kind of support are you currently receiving? *

May we connect with your Support Team? *

yes

no

Are you taking any medications? *

yes

no

For what purpose? *

Are you experiencing any of the following: *

Do you experience any physical limitations at this time? *

Do you have any Chronic Conditions? Allergies? *

What is your current level of Self-Love? 10 being the highest, 0 the lowest. *

Do you have a spiritual foundation in your life? *

yes

no

Please desribe: *

Are you currently working in a shamanic or mediumistic tradition? *

Yes

No

Which one? *

What would you like to gain from working together? *

Part of this intake is your non-refundable payment. The Ancestral Field Reading is $350 for both sessions. Additional sessions are $190/hour. To complete your initial request, please send $350 via paypal to Constellations@gmx.net. Thank you.

Thank you, I am sending the payment.

No thank you.

Please acknowledge our 7 day cancellation and rescheduling policy. True emergencies are accepted. Otherwise, full fee is due for all scheduled appointments. First-time appointments are prepaid. *

Yes

No

Do you wish to be added to our email list? *

Best day/time to schedule your appointment? *