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Welcome to SPIRIT CLEARINGS

Let's get to know each other a little more before we embark on this HEALING journey together!

First, Middle and Last Name*

Email*

Phone*

Mailing address*

Birth details (date, time and location)*

What interests you about a SPIRIT CLEARING? What would you like to accomplish, change, heal and resolve?*

How will your life be different after this process?*

Occupation, Relationship and Family Status*

Please state all therapeutic or wellness processes supporting you at this moment in time. This can be psychotherapy, body-therapy or any other form of healing service. *

Are you taking any medications?*

If so, for what purpose?*

Do you experience any physical or emotional problems or symptoms at this time?*

Do you have any allergies and other chronic conditions?*

Have you experienced any of the following?*

What is your recent level of self-love?*

Do you have a spiritual foundation in your life?*

Please describe your spiritual foundation.*

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

In your own words, please describe your symptoms and affects that you are experiencing. Tell me what is happening within you, your life and/or in your space and what would you like to change?

Describe all the challenges you are experiencing. *

What else would you care to share with me that you feel may be relevant?*

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

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

Referred By*

Payment Method*

Thanks for submitting!

submit above and then pay below

Additional Payment Options:

Pre pay with cash

Cash App $BryanCampbell0763

PayPal (friends & family) @bryancampbell0763 

Venmo (friends & family) @Bryan-Campbell-9

Zelle bryan0763@gmail.com

Gift card: Walmart, Publix or Amazon

Trade/Barter: services or items

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