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PayPal customers, please go to the on-line payment submission page to place
your order.
Non-PayPal customers, please complete and submit the form below
(don't forget to select your appointment/session number). I will contact you
directly to schedule your appointment once your payment has been verified.   
                                                                                                 ~Thank You!
Appointment Request Form
408-472-9245 (Phone)
Birth First Name:
Birth Last Name:
Birth Middle Name:
Birth Date:
Address:
Phone No:
Email:
Specific Issue You
Would Like To Have
Addressed (Optional):
Please specify (by number) in the box to your right
which appointment/ session you would like to
schedule:

#  1  - 15-Minute Numerology Reading -$35
#  2  - 30-Minute Numerology Reading -$65
#  3  - 45-Minute Numerology Reading -$95
#  4  - 60-Minute Numerology Reading -$125
#  5  - 90-Minute Numerology Reading -$185

#  6  - 1-Hour Past Life Regression Session -$125
#  7  - 2-Hour Past Life Regression Session -$250
#  8  - 3-Hour Past Life Regression Session -$375

#  9  -1-Hour Reiki Session - $65
#10 - 2-Hour Reiki Session -$130
Please check this box to request
a tape recording of your Reading
and/or Past Life Session (a
$5.00 shipping & handling
charge applies).