I used a Tarokka deck to do an in game fortune telling in my 5e conversion of the Pathfinder 1e gothic horror Carrion Crown adventure path.
The Tarokka deck is a D&D Ravenloft specific deck of fortune telling cards similar to the Tarot deck with numbered suit cards (swords, coins, glyphs, and stars) and individual high arcana ones. Mine were from the
2e Forbidden Lore boxed set which also has guidance on the meanings and associations of the cards and different ways to do fortune tellings and possible mechanical uses.
I had a central NPC ally suggest that she had a deck and ouija board and had used them as a child at party games and could try to do it to gain some understanding of a ghost mystery that was going on that the party was involved in.
I had her do a drawing for each member of the party where they drew cards for a fortune telling focused on them and the mystery.
A simple layout is a cross format the central card is the subject, the lower part of the cross is the past, the upper part is the future, and there is an ally and hindrance to the sides, I believe. In the PC's case they were the subject of their own drawings and drawing the cards out was very atmospheric.
Part of the key then is knowing the associations and tying them into what you know about the PCs and plot in your head so that what gets drawn can make sense for you and can be framed as elements for PCs to look out for that flag campaign themes or plot points or character aspects. How you describe the aspects in the reading can frame things evocatively
The fortune teller just relates the aspects and how they relate in the drawing, so the Necromancer card in the past slot for one PC I talked about the Necromancer being a black magician at the heart of the mystery who initiated the action which tied into one of the NPC villains who the party already suspected who had started the ghost sequence with a ritual murder. When I roleplayed the NPC doing her own reading for herself and her future was the card The Broken One, which is a doomed innocent hurt by evil, I could see how it could tie into the plot further on, and I roleplayed her gasp at seeing it and explain what a horrible future fate it foretold.
If you are not doing an adventure path it still works out well as future stuff is generally open ended aspects that will fit something at some point, or that can be used as DM inspiration for future plot development ideas.
Not being super familiar with all the aspects it was useful narratively to have the tarroka reader be not an expert herself who could pull out her references book to explain some of the symbology when I could not remember specifics for say the four of glyphs.