Mediumship Application

Welcome to the COSMIC BLUEPRINT

Full Name (First, Middle and Last Name)*

Email Address*

Phone*

Mailing Address*

Birth Details (Date, Time and Location)*

What Interests You about the Cosmic Blueprint Reading?*

What kind of transformation are you looking to experience through this process?*

Occupation, Relationship and Family Status*

Partner and Children's Full Names and Birthdays (if applicable)*

Do you have a spiritual foundation in your life?*

Please describe your spiritual foundation.*

Are you currently working in a shamanic or mediumistic tradition?*

What life questions are you sitting with?*

In your own words, please tell me what is happening in your life?*

What challenges you are experiencing? *

What are your preference for appointment times and/or days?*

Would you like to be added to our email list?*

Referred By*

Once you submit your application kindly continue to payment to complete your registration unless you are paying with cash. Cash is preferred.

Both application and payment are required before admission. And, if you haven't done so already get to know us HERE!