Online Registration form ANGELA BURKE The Healing Medium Please contact Angela by phone or email to discuss an appointment Before fillingout this form otherwise you will not be respondeded to. Please fill in the Form below and then pay for your session and click the Submit button at the bottom of the page Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress: *Phone *EmailCommentsPlease confirm your age and that you have Read, Understood and Agree to the Terms of the Disclaimer below *I confirm that I am 18 years of age or older and that I have Read, Understood and Agree to the Terms of the Disclaimer belowTerms of the Disclaimer *The Healer is a channel for the universal energy and makes no promise of a cure or the outcome. The healer regards your doctor to be in charge of your medical health and well-being. You are advised to keep up any medical treatment you are receiving and keep in contact with your Doctor. The Healer may suggest breathing exercises or visualizations to help you reach a calm, relaxed state before or after the session or for you to use at other times. All information is offered for personal and entertainment purposes and is not intended at any time to replace the advice, counsel or recommendation of any medical, psychological, legal or financial expert or any other professional service. Mediumship and Psychic work is experimental in nature and the information imparted during a session is open to interpretation. Clients are advised that they have free will at all times to make their own choices and Angela Burke shall not be held responsible for the actions they may or may not take as a result of their session. By signing this I am declaring I understand the above and I am in full mental health to receive a session from Angela Burke.PhoneSubmit Please pay for your session now by clicking on the link below