RESERVATION FORM

 
Please use the following Reservation Form to provide information
that will be used to schedule your appointment and conduct your reading.
NOTE: the birth information MUST be accurate
(this is not the time to lie about your age)
DON'T FORGET TO HIT THE SUBMIT BUTTON WHEN YOU ARE DONE!

BIOGRAPHICAL INFORMATION
First Name ---------------------------
Last Name---------------------
Address --------------------------
City, State, Zip--------------
Home Phone Number------
Work Phone Number-------
Fax -------------------------------
Email ----------------------------
Date of Birth ------------------------------------------
Place of Birth -----------------------
Time of Birth ------------------------------------
 
 
PLEASE IDENTIFY THE TIME AND DATE
YOU WANT TO RECEIVE YOUR READING
(Readings are scheduled daily between 11:00 am to 9:00 pm)
 
First choice for Reading (list time and date) -----------------------------
Second choice for Reading (list time and date) -----------------------------
 
 
 
PLEASE CHECK THE TYPE OF READING/ACTIVITY YOU DESIRE
 
Soul Mate Reading --------------------
Metaphysical DNAtm Reading------
PowerPathingtm-------------------------
Shadow Reading------------------------
Note: PowerPathing and Shadow Readings are available
at any time after a Metaphysical DNA Reading
 
 Walk-N-Talk Story Telling Fire Circle-----
 
 
PLEASE INDICATE HOW YOU WISH TO RECEIVE YOUR READING:
 
I wish to visit the Retreat for my reading ---------------------
 
I prefer to conduct my reading over the phone --------------
 

NOTE: For Readings in person at the Dancing Horse Retreat you can pay with cash, personal check, Visa, Mastercard, or American Express card at the time of the READING. For Readings over the phone, you must pay with Visa, Mastercard, or American Express.

 

 

PLEASE DESCRIBE WHAT YOU HOPE TO ACCOMPLISH WITH THE READING/ACTIVITY:

 
 
 PLEASE DESCRIBE ANY SPECIAL NEEDS OR CONSIDERATIONS. 

  

 PLEASE INPUT ANY QUESTIONS OR COMMENTS.

 _______________________

    

 

 

Note: if you have problems submitting this form please email us and we will send the form via email or fax.

YOU WILL BE CONTACTED BY PHONE OR EMAIL WITHIN 48 HOURS
CONCERNING THE STATUS OF YOUR RESERVATION. THANK YOU!

 

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