Client Info Form

Home
Book A Session
Astrology for You
Astrology for Parenting
- Parenting Classes
- Power Three Parenting >
Podcast
Blog
D&B SHOP
Contact

Client Info Form

Please Complete and Submit the form below for your purchased astrology session.

* Indicates required field

Name *

First

Last

Location (if different from Birth place) *

Email *

Phone Number *

Make sure this is the number I would call for a phone or Facetime session.

Your Date of Birth (Month, Day,Year,Time & Place) *

Please provide DOB plus an accurate time of birth and full location information (City, State, Country).

Additional Birth Info for any others needed for synastry sessions or that you would like available for insight to support your session. *

Please provide DOB plus an accurate time of birth and full location information (City, State, Country).

Relationship Status *

Married Single Dating It's Complicated

Occupation, career, line or work... *

Area(s) of concern or interest for reading: *

Please share any situation or info you feel necessary so I can be the most helpful.

Where in yourself or life would you most like to improve or create change? *

What are your highest hopes for our session together? *

Consultation Options *

Zoom (recording included) Facetime (must record on your end) Phone (must record on your end)

Best Available Times (Mon-Fri) *

Mornings Afternoons Evenings

Have you had an Astrology reading before? *

YES NO

Level of Astrology Knowledge/Interest *

How did you find me? *

Terms & Conditions: Please confirm that you understand and agree that this is a consultation where I offer my astrological insight and perspective to the best of my ability to shine a light on your journey. I honor your privacy and do not share your personal information or our work together with anyone else without your written permission. *

I agree

Submit

Shortcuts

Get In Touch

Get my monthly newsletter with Astrology insight, tips and teachings.

SERVICES

LEARN

SHOP

I'd love to hear from you and connect on social media! Reach out!

Client Info Form

Newsletter

Shortcuts

Get In Touch