Request Form for services

To fill and to send to me by the post office :
Francine Guimond
105 rue Laurier, Ste-Catherine-de-la-Jacques-Cartier,
G3N 0V6, Quebec, Canada

by e-mail :
Communicationanimale_francineguimond@live.ca
or
francineguimond@hotmail.com

Your Name : *
Telephone (and approximate hour where it is easier to join you) *
E-mail : *
Name of the animal :
Is the animal?	living deceased
Species and Race :
Age of the animal (or age of the death) :
Summarized history of the animal (since when have it? Outstanding events of its life,….) :
Condition physical (physical diseases, accidents, current state,….) :
Has it disorders of behavior or bad habits, so yes which? :
Do you have other animals at the house?	yes no
Your questions :
Basic training in animal communication	yes no
Type of consultation
Number of animals
Places (if suitable)
Verification:

...and do not forget to include the photography of your animal.