Please NOTE the appointment time is based on Eastern Time (New York Time).  Please convert to your time zone using http://www.timeanddate.com.

Please complete the following information, sign the disclaimer and submit to Stacey ASAP, so she can prepare for your session.

All Fields Are Required.

Which session did you purchase?

Cash GridMedical Intuitive Reading Healing SessionCareer Reading Healing Session

Your Email

1. Full name as listed on birth certificate:

2. Date of birth, including year

3. Current occupation

4. Current location: city, state, country

5. Physical and/or emotional symptoms or health issues - be specific

6. What medications, supplements, homeopathic remedies, herbs, etc are you taking, if any?

7. Are you currently under the care of a physician, therapist, alternative healer, chiropractor, etc? If so list here, along with their names and what they currently treat you for.

8. Please also submit a digital photo if available, to stacey AT sentelligentsolution.com

Disclaimer:

Stacey Mayo is a Sentelligent Medical Intuitive and Sentelligent Healing Facilitator and not an M.D. Be sure to explain your situation fully. She will make suggestions and it is up to you to discern and take responsibility for your own choices. If you have any concerns about what she suggests, feel free to ask her to further explain and engage in dialogue with her. Consult your regular doctors and other practitioners when you believe it makes sense for you to do so.

By reading this disclaimer, you agree to take responsibility for your own health and the choices that you make and ascertain that the information you provided here is accurate to the best of your knowledge at this time.

Please put your name and date in the box and then submit.