Energetic Clearing Intake Form

Product

1- Person Energetic Clearing$110

Client: Person paying for and ordering the energetic clearing

Client's First Name

Person Paying/Ordering the clearing

Client's Last Name

Client Email

**Where the Clearing Report will be sent

Recipient: Person receiving the energetic clearing

Full Name

Person Receiving the Clearing

Date of Birth

Person Receiving the Clearing

Current Location

City, State, Country

Reason for Booking...

You are higly encouraged to provide further details as needed, if dealing with negative thoughts, depression, anxiety, physical, medical, or metaphysical curiosities, nightmares, etc

How did you hear about us?

Friends/Family

Social Media

Spirit Release Academy

Other