Akashic Intake Form page | Build Life Balance

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We Are Coming

Thank you so much for being here! I am very excited to work with you!

Please fill out this brief form before we begin our session. Looking forward to seeing you soon

First name*

Last name*

Email*

Phone

What is your primary intention for this Akashic Records reading?*

Seeking clarity on life purpose

Understanding relationships

Healing past traumas

Exploring past lives

Career guidance

Personal growth and spiritual development

I'm just looking for some general guidance

Other

Choose any and all options that apply

Have you ever had an Akashic Records reading before? Yes/No*

How would you describe your current spiritual or personal growth journey?*

Just Starting Down This Path

I've Been Exploring This For A While

I'm Pretty Deep Into The Journey

Other

Is there anything else you would like me to know before our session?*

Again, please only share what you feel comfortable sharing. Know that this is a safe place and none of your personal information will be shared.

How did you hear about our Akashic Records reading service?*

Social Media

Website

Flyer

Other

If referred, please list who referred you in the "other" section.

I confirm that I am over 18 years old

Please Confirm Your Birthday*

Month

Day

Year

By submitting this form, I consent and give my permission to use my information for the purpose of conducting the Akashic Records reading. I understand that the reading is for guidance purposes only.*

Yes Please, I'm ready for my reading

No Thank You, I changed my mind

Other

Note: If No is selected, I will not be able to do the reading.

Signature

Signature field is empty.

Looking forward to working with you! ~Angie

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