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Session Order Form
Your Information
First Name Last Name Address City State AK AL AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code Out of U.S. Address
First Name Last Name
Address
City State AK AL AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code
Out of U.S. Address
Phone
Email
How did you hear about Animal Connection? If a specific person referred you,please let me know their name or email address.
Order type: Standard Session Reassurance Session
Send my report as: Text within an email MS Word attachment to an email
Your Animal's Information
Animal Name Male Female Age years months How long have you been together? years months
Animal Name Male Female
Age years months
How long have you been together? years months
Dog Cat Horse Bird Other
Physical description of the animal including breed, coloring, and size. You may also email a picture or snail mail a picture which will be returned if requested.
City and State where the animal is located if other than the address above.
Questions
Standard Session: Please list the 5 questions/areas you would like me to discuss with your animal for a Standard Session. Please be sure to describe the question thoroughly, so I can picture them accurately for your animal. Feel free to add any background you would like. OR Reassurance Session: Please list the issues that you would like me to discuss with your animal.
Standard Session: Please list the 5 questions/areas you would like me to discuss with your animal for a Standard Session. Please be sure to describe the question thoroughly, so I can picture them accurately for your animal. Feel free to add any background you would like.
OR
Reassurance Session: Please list the issues that you would like me to discuss with your animal.
Picture of animal provided by: Email U.S. Mail No picture. Use my description
Email pictures to Animal Connection at AnimalConn@aol.com.
$35 payment will be provided by:
PayPal.com
To place your order you MUST click on the Submit button below!
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