Chakra Reading Booking FormFirst NameLast NameMobile NumberEmailDate of Birth (if the reading is for yourself)Is this a gift? Yes NoIf YES, please provide the full name of the recipient.If YES, please provide date of birth if you know it.If YES, please provide email / address for the PDF to be mailed.If YES, please acknowledge that any information provided to the receipient should remain private and confidential YES I AGREEIf there is anything you would like to add that is not included in this form please comment below.Please acknowledge that the information given in the Reading should not be treated as a substitute for professional medical advice, always consult a medical practitioner. Any use of information in the reading is at the readers discretion. Michelle Potter Artist cannot be held responsible for any loss, claim or damage arising out of the use, or misuse of the suggestions made, the failure to take medical advice, or for any material on third party websites. YES I AGREEWhat happens now? Once I have received your form, I will contact you via email. My preferred method of payment is via PayPal so an invoice will be sent to the email provided. Please be aware that times may vary depending on bookings and my work schedule. From time to time I need to step away from work to recharge. Bookings are not confirmed until you receive email confirmation and payment must be received prior to the commencement of any work.Submit Form
