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For Parents
Do you accept texts on your cell phone?
*
Yes
No
Have you ever had a Group or Personal Reading with Ruthie before?
*
Yes
No
RE-ENTER CELL PHONE
*
RE-ENTER YOUR EMAIL
*
EMAIL
*
Feel free to add a special note for Ruthie below:
How old was your child when they passed?
*
What was the date of your child's passing?
*
What time zone are you in?
*
Eastern
Central
Mountain
Pacific
Hawaiian
Alaskan
Other
If you're planning to bring another person, please share who will be accompanying you for this reading:
This contact form is for parents who have lost a child.
Is this session by yourself?
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Yes
No
What type of appointment are you interested in?
*
Complimentary Phone Reading (for parents who have lost a child through death)
Complimentary Phone Reading (for parents of missing children)
MAILING ADDRESS (optional)
CELL PHONE
*
NAME (last name optional)
*
Please fill out the form below to contact The Bean Town Medium!
Contact Form for Parents
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