School of Metaphysics Bookstore Intuitive Report Request and Information

Health Analysis Request Form

INTUITIVE RESEARCH

Individual Intuitive Health Analysis Request for you to print, fill out, and return to us

Name ______________________________________ Date of Birth _
(Please type/print as on birth certificate. Females who have married use most recent husband's last name.

Address
Street number and name or Route/Box number

_
City / State / Postal Code / Country

Phone Number email: ____

Occupation Have you studied at the School of Metaphysics? _

___________________________ and ____________________________
Date of two consecutive Tuesdays you will be at this address from 7-11 p.m. Central Time

_____________ _
Street address where you will be at the time of your analysis City / State / Country

Signature (of person requesting reading) _________________________________________________

If you have questions or specific concerns please write these on the back of this sheet.
List in order of importance. If your questions exceed five please call us.

Requested minimum donation for this type of Intuitive Report is $80. Your generosity is greatly appreciated for it enables us to further our work. One hundred percent of monies received are used for expansion of SOM teachings and research.

Form of Payment (circle one): Check/Money Order (payable to School of Metaphysics) Visa Mastercard Discover

Amount Enclosed: $___________________

Visa/MC Number: ______________________________________________ Expiration Date: ______________________

Signature of Cardholder: ____________________________________________________

Please send completed form with indicated form of payment to:

School of Metaphysics
World Headquarters
163 Moon Valley Road
Windyville, Missouri 65783
USA

*International orders please add $15.00 for return priority mail.

(please do not write in this box)

Check Out Register View/Edit Cart

Return to Bookstore

Individual Intuitive Health Analysis Request for you to print, fill out, and return to us

Name ____________________________________________________________________ Date of Birth _______________________________ (Please type/print as on birth certificate. Females who have married use most recent husband's last name.

Address __________________________________________________________________ Street number and name or Route/Box number ___________________________________________________________________ City / State / Postal Code / Country

Phone Number ________________________________________ email: ____________________________________________

Occupation ________________________________ Have you studied at the School of Metaphysics? _________________________________

_______________________________________________________ ___________________________________________ Street address where you will be at the time of your analysis City / State / Country