Selacia's Pet Healing Form

Selacia's Pet Healing Background Form

Thank you for scheduling a Pet Healing session with Selacia.

NOTE: Your information will never be shared with outside sources. See below for privacy statement.

Your Name

Date

Referred By

Your Pet's Information:

Pet's name

Breed and Type of animal (collie dog, persian cat, quarter horse, etc.)

Gender

Age

Size and Weight

Body Color, Fur Length, and Type (short, medium, long, curly, straight, etc.)

Eye Color

Distinguishing Marks

Pet's Veterinarian

How long have you had your pet?

If your pet had a previous guardian(s), describe any known circumstances (e.g. whether the guardian had other pets, why the pet was sold or given away, etc.)

Provide information about any other pets you have (name, type of animal, breed, gender).

Describe how your pet interacts with the other animals and people in the household.

Is your pet indoor/outdoor/both?

What type of food does your pet eat?

List major health conditions for which your pet has received veterinary care and the year in which they occurred.

Is there anything that seems to bother or scare your pet?

Why did you select your pet?

What benefits do you receive from living with your pet?

What is your pet’s favorite place(s) to spend time?

Briefly describe what particular condition(s) you would like to resolve on behalf of your pet and how long your pet has experienced this. Also, describe what medical/other treatments your pet has had for this condition (if applicable), and any medical diagnosis.

Provide here information you would like Selacia to telepathically communicate to your pet during the session. Also, provide questions you would like Selacia to telepathically ask your pet.

Your Information:

Street Address

City/Town

State/Province

Zip/Postal Code

Country

Home Phone

Daytime Phone

Cell Phone

FAX

Email Address

Best Timeframe for Sessions (Figured in California Pacific Time please.)

Age

Birthdate

Birthplace

Marital Status

Number of Children

Present Occupation

Occupation before illness (if applicable)

Spiritual or Religious Orientation

Hobbies or Leisure Activities/Interests

Present Physician

Have you ever experienced psychic or spiritual healing? When? With whom?


Please list all past major illnesses and surgeries and the year in which they occurred.

Are there any residual effects/what?


Briefly describe what particular condition(s) you would like to resolve personally and how long you have experienced them? Include with this both physical and emotional/mental conditions.

Of these conditions, what is your priority as you begin any personal healing work with Selacia?


What medications or nutritional supplements do you take regularly and for what purpose?


If you would like to join Selacia’s opt-in Mailing List, please indicate your interests below. In the future, you will receive periodic emails specific to your interests. Many times, announcements are made only to Selacia’s email list, so this is the best way to be kept informed. You can choose, at any time, to unsubscribe, or to receive less or more information.
Selacia's Mailing List categories:
Books by Selacia
Channeling evenings
Crystals and crystal healing
DNA intuitive healing
Nonphysical world
Nutrition and rejuvenation
Pets
Teleclasses
Wesak celebrations

Comments:

REQUIRED FIELD:
For security purposes, before you Submit, please enter the code shown in the image below. It is recommended that you first print out this form so that you can have a copy for reference.

Privacy Statement
Privacy is important to us; therefore, we will not sell, rent, or give your name and address to anyone. You may choose, at any time, to unsubscribe from Selacia’s Mailing List.

© 2000-2007,
Communication for Transformation Group
All rights reserved.

Your Name
Date
Referred By
Your Pet's Information:
Pet's name
Breed and Type of animal (collie dog, persian cat, quarter horse, etc.)
Gender
Age
Size and Weight
Body Color, Fur Length, and Type (short, medium, long, curly, straight, etc.)
Eye Color
Distinguishing Marks
Pet's Veterinarian
How long have you had your pet?
If your pet had a previous guardian(s), describe any known circumstances (e.g. whether the guardian had other pets, why the pet was sold or given away, etc.)
Provide information about any other pets you have (name, type of animal, breed, gender).
Describe how your pet interacts with the other animals and people in the household.
Is your pet indoor/outdoor/both?
What type of food does your pet eat?
List major health conditions for which your pet has received veterinary care and the year in which they occurred.
Is there anything that seems to bother or scare your pet?
Why did you select your pet?
What benefits do you receive from living with your pet?
What is your pet’s favorite place(s) to spend time?
Briefly describe what particular condition(s) you would like to resolve on behalf of your pet and how long your pet has experienced this. Also, describe what medical/other treatments your pet has had for this condition (if applicable), and any medical diagnosis. Provide here information you would like Selacia to telepathically communicate to your pet during the session. Also, provide questions you would like Selacia to telepathically ask your pet.
Your Information:
Street Address
City/Town
State/Province
Zip/Postal Code
Country
Home Phone
Daytime Phone
Cell Phone
FAX
Email Address
Best Timeframe for Sessions	(Figured in California Pacific Time please.)
Age
Birthdate
Birthplace
Marital Status
Number of Children
Present Occupation
Occupation before illness (if applicable)
Spiritual or Religious Orientation
Hobbies or Leisure Activities/Interests
Present Physician
Have you ever experienced psychic or spiritual healing? When? With whom?
Please list all past major illnesses and surgeries and the year in which they occurred.
Are there any residual effects/what?
Briefly describe what particular condition(s) you would like to resolve personally and how long you have experienced them? Include with this both physical and emotional/mental conditions.
Of these conditions, what is your priority as you begin any personal healing work with Selacia?
What medications or nutritional supplements do you take regularly and for what purpose?






If you would like to join Selacia’s opt-in Mailing List, please indicate your interests below. In the future, you will receive periodic emails specific to your interests. Many times, announcements are made only to Selacia’s email list, so this is the best way to be kept informed. You can choose, at any time, to unsubscribe, or to receive less or more information. Selacia's Mailing List categories: Books by Selacia Channeling evenings Crystals and crystal healing DNA intuitive healing Nonphysical world Nutrition and rejuvenation Pets Teleclasses Wesak celebrations Comments: REQUIRED FIELD: For security purposes, before you Submit, please enter the code shown in the image below. It is recommended that you first print out this form so that you can have a copy for reference.