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  

       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

      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.   

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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.

      Picture of animal provided by:    Email    U.S. Mail    No picture. Use my description

       Email pictures to Animal Connection at AnimalConn@aol.com.

     $25 payment will be provided by:

              PayPal.com  Send PayPal credit card or debit card payments to AnimalConn@aol.com.      
            Check/Money Order

                                      Send check/money order to:

Animal Connection
10315 Quail Canyon Road
El Cajon, CA 92021-2224

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