Page 1 of 1

Private Reading Request Form

Please complete this form carefully.

I will review your request and send your payment link by email if your reading is accepted.

Full name or nickname

Email address

Gender

Male

Female

Prefer not to say

Birth date

Birth time (if known)

Example: 07:25 AM / 19:40 / Unknown

Birth place

City, State/Province, Country

Which reading would you like to request?

Relationship Pattern Reading — $39

Timing Reading — $39

Year-Ahead Reading — $49

What is your one main question?

Please keep it to one main question so the reading stays focused and useful.

Is there anything important I should know before I begin?

Please confirm

I understand that this reading is for personal insight and reflection only. It is not medical, legal, or financial advice. No guaranteed outcomes are promised.