Fellowships of the Spirit

Confidential Feedback Form

1. Reader/Healer*
   - Select -Amanda_Krouskop Amy_Atkinson Amy_Muro Andrea_Pouw Brooke_Winkler Cara_Stockdale Colleen_Fritz Connie_Carlson Connie_Field Donnell_Sullivan Irene_Lavin Jared_Hotaling Jina_Johnson Julie_Lawson Julie_Toth Karen_Getter Kimberly_Ferris Leslie_Gillen Lori_Drawl Lynn_Sneath Mark_Dressler Mary_Haeberle Melissa_Longo Michaelene_Clevenger Michelle_Sweet Nikki_Hotaling Pamela_Maryanski Pat French Peter_Monkberry Seva_Aston Youapa_Yang

   select your reader/healer
2. Date: *
   -MM- 01 02 03 04 05 06 07 08 09 10 11 12 /  -DD- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 /  -YYYY- 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034
3. Client's Name: *
4. Gender: *
   Male
   Female
   
5. Phone Number:  
6. Street Address:  
7. City/State/Zip:  
8. Email Address: *
   (use none@none.com for none)
9. May I add you to email list?:  
   Yes
   No
   
10. Would you host a reading party?:  
    Yes
    No
    
11. Referred by:  
12. Was a spiritual reading given?: *
    Yes
    No
    
13. Spiritual Reading Reason?:  
    Curiosity
    Guidance
    Information
    Insight
    Self Discovery
    Spirit Contact
    Other
    

    (check all applicable)
14. Spiritual Reading Was?:  
    Accurate
    Relevant
    Specific
    General
    Personal
    Insightful
    Healing
    Meaningful
    

    (check all applicable)
15. Spiritual Reader Was?:  
    Considerate
    Helpful
    Professional
    Relaxed
    Understanding
    

    (check all applicable)
16. Was spirit contacted?:  
    Yes
    No
    
17. If spirit was contacted, did you recognize?:  
    Yes
    No
    
18. What was significant about the reading?: