Intake Form

    1. Required information for your consult

    Full Name *

    Email *

    Phone *

    Preferred contact method:


    Location of Birth:

    Birth Time:

    Source of Birth Time:

    Current Location & Country of Residence:


    Relationship Status:

    Occupational Status:

    2. Do you have any previous astrology background or studies? Which form or lineage, if

    3. Please provide 3 life events (graduation, marriage, childbirth, big move, retirement, etc) along
    with their dates (month and year). This information is used for birth time rectification purposes.

    Life Event #1 and Date:

    Life Event #2 and Date:

    Life Event #3 and Date:

    4. Please note any questions or topics you'd like to focus on during our session. This exercise helps
    you clarify your intentions, and it helps me in preparation / research prior to our meeting. Your
    thoughts may be as specific or open-ended as you wish! Our discussion may likely touch on
    other areas as well; however, these topics will be our starting point.

    Question #1:

    Question #2:

    Question #3:

    Cancellation policy - Missed appointments and cancellations with less than 24 hour notice will not be refunded except for extenuating circumstances.