Astrological Birth Chart Reading Intake Form

Astrological Birth Chart Reading Intake Form

We will reach out to you within 2 business days to schedule a session, which will take place here at Salt Your Soul Gift Co. We need 3-5 days to put together your birth chart, which you will get a copy of at your session. The $129 fee will be due once we schedule a day and time for your session.
Name

First NameLast Name
Email
example@example.com
Choose the days and times below when you'd like to have your session. AM = between 10AM - 12PM and PM = 1PM - 4PM. Sessions are 50 minutes (choose all that apply):
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Birth (as accurate as possible)

Hour Minutes

AM/PM Option
Place of Birth (City, State, Country)
On a scale of 1 to 5, how familiar are you with astrological concepts?

1

2

3

4

5

1 is Not at all Familiar, 5 is Very Familiar
Which areas of your life are you most interested in exploring during this reading? (Select all that apply)

Other
Do you have any specific concerns or challenges you'd like to address?
Is there anything else you would like to share that you feel is relevant to your birth chart reading?
Should be Empty: