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Please fill in the below form

To give you a reading, I need access to your Akashic record. Your Akashic record contains information about your soul, current life, past lives, and spirit guides.

To access your Akashic record I need some of your personal details. They'll be kept secure and private.

The fields with a red asterisk beside them (*) denote information I need to access your Akashic record, and provide you with a high standard of service.

All other fields are optional. Only fill them in if you want to.

Once you've completed the form, you will be sent to a confirmation page and a copy of the information you enter below will be sent to the email address you provide.

Thanks!

Your full name *

I.e. Your first name(s), middle name(s), and surname(s).

Your full name is required so I can do your reading.
Your full name at birth

Only fill out this field if the name you have now is different from the name(s) you were given at birth.

If your current surname is different from your maiden name, please fill out this field.
Your town or city of birth *
Your country of birth *
Your date of birth * DD / MM / YYYY
Example format:
27 / 12 / 1986

(i.e. day, month, year)
Do you give me permission to store your information in my secure, private client database? *
Yes, I give you permission. No, I don't give you permission.

Do you give me permission to store:

1. the information you've provided me here.

2. notes or records of information from or for your reading.

… in my secure, encrypted client records (1) in case you book another reading with me, and (2) for my personal reference?
--------------------------------
If you say no, the only information I keep is:

1. your full name.

2. your contact details (i.e. phone number, Skype address, or email address).

3. correspondence (i.e. emails, letters, etc).

4. your website address, anything you add, say, or ask, and how you found my website (if you provide me that info here).

Any other records, notes, as well as details you've provided here will be deleted once they're longer needed for your reading.

Read my privacy policy to learn what I do (and don't do) with your information:

www.bruceachterberg.com/privacy-policy/
Your website

Do you have a website?

If not, do you have a Twitter, Facebook, or other social media account?

If so, please share the address!
Is there anything else you'd like to add, say, or ask?

If you have anything else you'd like to include in your personal details submission, please do so here.
How did you find my website?

You don't have to answer this if you don't want to, but I'm genuinely curious about how you found my site. :)

Such information also helps me provide more value by targeting my efforts more effectively.
Do Not Fill This Out

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