Animal Paradise - Communication & Healing
The Underground Peace Movement
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    Client Information Form 

We are NOT accepting Animal Communication clients at this time.

 We ARE offering Human and/or Animal Reiki sessions.

Client Information Form


Zip Code:
Email Address:
Please be sure to include your email address or we will not be able to contact you. Thanks.
Home Phone:
Work Phone:
Mobile Phone:
Your Time Zone   EasternCentralMountainPacificOther

Reffered by; or How You Learned About Animal Paradise:


 Your Animal's Name:




 Animal's age:


 Your Animal's Gender:

 Your Animal's Approx. Weight:


 Number of Years You Have Had Animal:


Where Did You Get Your Animal Companion; Shelter, Breeder, Friend, etc.:


Has Your Animal Been Spayed or Neutered


Is Your Animal Indoor Only, Outdoor Only or Both:

Brief Description Such As Color, Long or Short Hair, Eye Color, Speical Markings, etc.:


List All Other Animal Companions That Live With You: Name, Age Breed, What Kind of Animal, Gender and All Human Companions That Live in the Household (1-Adult Female; 1-Female Child, etc.):


What Would You Like to Focus on In This Session Or What is the Nature of the Problem?:


Please choose One: Phone-Email-Barn-Home Consultation:

Please enter numbers into the box on the right: *  


Animal Communication is not a substitute for good veterinarian care. Only a licensed veterinarian can legally diagnose and prescribe medicines. Each states laws vary. Please consult your veterinarian for any health care concern. 
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