Client Info Form - Nurturing Astrology

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Client Info Form

Please Complete and Submit the form below for your purchased reading.

* Indicates required field

Name *

First

Last

Location (if different from Birth place) *

Email *

Phone Number *

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

Please provide DOB plus an accurate time of birth and full location information (City, State, Country). Include child or partner names and info here as well if doing a synastry reading.

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.

Consultation Options *

Zoom Facetime Phone

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

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Home
Book A Session
Writings
Podcast
Astrology for Parenting
- Parenting Classes
- Power Three Parenting >
Astrology for You
D&B SHOP
Contact
- Client Info Form
- Podcast Q Form