Astrology Consultation Questionnaire

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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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What kind of engagement are you complete this questionnaire for?
1:1 Birth Chart Consultation
Group Workshop
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Hello there! I am excited to meet with you to discuss your astrological profile and explore what insight it might provide for you. Your completion of this questionnaire gives me the information I need to prepare for our time together, as well as how I might shape the consultation to meet with your specific experiences and desires. Thank you in advance for your responses!
6
Hello there! I'm excited to have you participating in the upcoming NEW *LIFE* ORDER workshop. By completing this questionnaire, you are reserving your spot for the workshop, as well as providing me with the information to provide you with a birth chart to use during the workshop. Thank you in advance for your responses!
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Which date do you plan to attend the workshop?
Thursday, Jun 25: 7pm - 9pm
I'm not sure yet
Wednesday, Jul 8: 6pm - 8pm
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Do you plan to attend the pre-workshop orientation on zodiacal Signs and astrological Houses one hour before the workshop? (This is recommended for those with little to no experience with the Houses.)
Yes
No
Maybe
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Date of Birth* This field is required.
Date
Year
Month
Day
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Location of Birth (i.e. City, State)* This field is required.
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Do you know your time of birth?* This field is required.
Yes, I have the time recorded on my birth certificate (or something very, very close).
I have an estimated time based on the memory of a family member.
No, I do not know my birth time.
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Time of Birth (please include AM/PM)
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Estimated Time of Birth: Please feel free to give a time of day (i.e. sunrise, late afternoon, etc.) or a time range (if giving time(s), please include AM/PM).
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What is your prior experience with astrology? Have you received any consultations in the past? Have you studied or read about astrology?* This field is required.
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What question(s) or life circumstance(s) are prompting you to seek out an astrological consultation at this time? * This field is required.
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Please provide a brief biography outlining major time periods, events, and transitions in your life. Please include information about your family (parents, siblings, etc.), as well as any details about your birth of which you are aware.* This field is required.
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How would you like to meet for this consultation?
Google Meet (I will provide a link)
In person (Greater Pittsburgh area only; I will reach out, and we can select a meeting place)
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WORKSHOP PAYMENT INFORMATION

This workshop has a sliding scale fee structure: $24 - $60.

To support accessibility while recognizing the value of this work, participants are invited to choose the rate that best reflects their circumstances. Those who select the Supporter rate help make Community-rate participation possible for others.

Community: $24

Standard: $42

Supporter: $60

After selecting the amount most aligned with your personal finances, you can:

1. Pay in advance via Venmo @lee-saville-iksic;

OR

2. Pay on the workshop day via Venmo or cash.
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Is there anything else you would like me to know?
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