Professional Clearing Intake Form

Althea Gray, Human Potential Healer

Our Purpose is You

Professional Clearing Intake Form

*If there is more than one person or more than one address that you want to clear, email Althea.

*Month-Day-Year
*Name that you use everyday
*Month-Day-Year, Time & Place if known
*Please include suite nos. apt nos. room nos, if any.
*Please leave the best number without any spaces or symbols in between numbers. For example: 5059824242
Althea Gray
Santa Fe, New Mexico 87505
Phone: (505) 983-9582
Email: althea@altheagray.com

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