Full Name *

Todays Date *

Full Name as is appears on your Birth Certificate ~ Please provide FIRST, MIDDLE and LAST name.  

Your Email Address*

Phone Number *


Area Code             Phone Number

Date of Birth *

Location of Birth ~ Please include City, State, Country *

Time of Birth if you know it

Current Location ~ Please include City, State, Country *

How would you like your session conducted

1 Question, 2 Question or 3 Question Email Session? Please include your questions here:

Skype Session? Please send contact request to Colleen Lemma. Once she accepts your request, she will be able to contact you via Skype at your scheduled appointment time. Add your Skype name here:

For additional "significant others" to be included in your reading, please provide: *Full Name as it appears on their birth certificate, *Date of Birth, *Time of Birth(if you know it), *Location of Birth.

Additional information you would like to share: 

Please note that all scheduled appointments are in the Eastern time zone. Please make sure you understand the correct time of your appointment. *

Yes I understand :) 

I hereby apply and consent to a session by Colleen Lemma, C.Ht., R.M.P., who has explained to me the general process and various results of Hypnotherapy, Reiki/Long Distance Energy Work, Sacred Soul Healings, Sacred Soul Guidance Sessions and Spiritual Readings/Consultations. I understand that the Practitioner does not treat, prescribe for, or diagnose any illnesses, disease, or any other disorder, injury, or condition, nor does the Practitioner claim to heal the previously mentioned. Nothing said or done by the Practitioner should be construed to be such. I further understand that the Practitioner is not attempting to practice medicine, psychology, osteopathy, chiropractic, physical therapy, or any other profession requiring a license. I understand that it is necessary for the Practitioner from time to time to assist me in relaxation for the physical and emotional changes to occur which I seek. I give the Practitioner my permission and consent to do all those things necessary in helping me establish such a state of relaxation and/or spiritual understanding, to help facilitate the process of change. I acknowledge that I am free to terminate any session or all sessions at any time, and that I have agreed to participate in each session out of my own free will

I read the consent form and agree

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