Merchant Services
1.

1.

To request a private session, please fill in this form. Sessions are provided between 12 noon and 5 pm Pacific time every day.

All fields are required except as indicated.
2.  First Name

2. First Name


3.  Last Name

3. Last Name


4.  Address

4. Address


5.  Phone Number

5. Phone Number


6.  Email

6. Email


7.  Best time OR days for session (give 3 choices) 12-5 pm Pacific time

7. Best time OR days for session (give 3 choices) 12-5 pm Pacific time


Preferred medium of session - phone, in person**, or via Skype***

Preferred medium of session - phone, in person**, or via Skype***


Preferred method of contact - phone, email, mail

Preferred method of contact - phone, email, mail


8.  Animal Information

8. Animal Information


9.  Private Sessions - $95 per 30 minutes

9. Private Sessions - $95 per 30 minutes

We will contact you to confirm your scheduled time and date and supply other pertinent information.
10.  Bill To

10. Bill To

First Name*

Last Name*

Address*


City*

State*
Postal Code*

Country*
Email*

Work Phone

Home Phone*

Cell Phone

* Required information.

** In person sessions are held in our facility in most cases. We can travel short distances (30 minutes or less) to in person sessions based on availability of additional time to be allotted for travel. (Travel fee would apply.)

***Must have Skype account (free) for Skype-to-Skype calls.

#Sessions can be rescheduled up to 2 times within 30 days of the original scheduled date if you have an emergency.  There can be no refunds.  Under some circumstances, a credit for a future session may be provided.


11.  Verifier

11. Verifier

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