FORM | Heaven and Earth

I'm looking forward to our phone call; please allow 45 minutes for our talk. PLEASE CALL 206-755-8152 at that time. The information you provide below will help me prepare for our conversation. (All info is completely confidential.)

ABOUT YOU

Date

First Name

Primary phone

Email address

Last Name

Alternate phone, if applicable

City, State

How did you find me? (online directory, general web search, referral, etc.)

Have you ever worked with an animal communicator before?

YOUR PETS:

Pet 1: (the one you are primarily concerned about)

Name, Sex & Age

Type/Breed/Looks

Age of pet when you acquired it:

Was it a rescue?

Current health + demeanor and any previously-diagnosed conditions

List any supplements or medications your pet is currently taking.

What are you currently feeding your pet? Wet, dry, etc.

Pet 2:

Name, Sex & Age

Type/Breed

Pet 3:

General health and demeanor (brief is fine)

Name, Sex & Age

Type/Breed

General health and demeanor (brief is fine)

YOUR PET'S ENVIRONMENT:

Other people living in your household/relationship to you?

Any recent changes in your household? Any stressors

CONCERNS:

Current/specific difficulties or concerns with the pet(s) you contacted me about:

Severity of the situation, rank 1-10 (10 being the worst)

On a scale of 1-10 (with 10 being the highest) please rate your willingness to try using an "unconventional" solution (such as animal communication) to the problem:

If you answered the previous two questions with a "7" or less, describe how bad the problem has to get for it to become a ""10".

Solutions you've tried

Why do this think this did not work?

Anything else you'd like me to know prior to our call?

Thanks for submitting!