Astrology Consultation Questionnaire

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Date of Birth* This field is required.
Date
Year
Month
Day
5
Location of Birth (i.e. City, State)* This field is required.
6
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.
7
Time of Birth (please include AM/PM)
8
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).
9
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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Ok
10
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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11
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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12
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)
13
Is there anything else you would like to share at this time?
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Ok
Should be Empty: