Please complete this form to request a private reading . . .

PayPal customers, please go to the on-line payment submission page to place
your order. Non-PayPal customers, please complete and submit the form below
(don't forget to select your appointment/session number). I will contact you
directly to schedule your appointment once your payment has been verified.
~Thank You!

Appointment Request Form

numerologywithatwist@comcast.net

408-260-1801

Birth First Name:

Birth Last Name:

Birth Middle Name:

Birth Date:

Address:

Phone No:

Email:

Specific Issue You
Would Like To Have
Addressed (Optional):

Please specify (by number) in the box to your right
which appointment/ session you would like to
schedule:

# 1 - 15-Minute Numerology Reading -$35
# 2 - 30-Minute Numerology Reading -$65
# 3 - 45-Minute Numerology Reading -$95
# 4 - 60-Minute Numerology Reading -$125
# 5 - 90-Minute Numerology Reading -$185

# 6 - 1-Hour Past Life Regression Session -$125
# 7 - 2-Hour Past Life Regression Session -$250
# 8 - 3-Hour Past Life Regression Session -$375

# 9 -1-Hour Reiki Session - $65
#10 - 2-Hour Reiki Session -$130

Please check this box to request
a tape recording of your Reading
and/or Past Life Session (a
$5.00 shipping & handling
charge applies).