Client Intake Form | Gurney Institute of Animal Communication

How did you hear about The Gurney Institute?

Name*

First Last

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone*

Work Phone

Referred By

Relationship to the Animal

Major Category**

Animal Information

Animal Name*

Nickname

Age*

Approximate Weight*

Sex*

Breed*

Coloring: Please describe special markings and length of hair*

Eye Color*

Indoor or Outdoor Animal*

If lost, was the Animal wearing a collar? How long gone and how lost?

How long has the person had the Animal; or how long has the Animal lived with the person?

Where did the Animal come from originally?

Is the Animal friendly?*

Has a veterinarian been contacted? If yes, please explain their findings.

Has any other Animal Communicator communicated with the Animal?*

What specific questions would you like asked?

What specific information would you like the Animal to know?

What is the most important information/result you want from the session?

Name

This field is for validation purposes and should be left unchanged.