Client Details

Please include all birth data: Month (written out ie: September NOT 09), day, year, city and time of birth and make sure you have made your payment. Thank you!

 

NAME*

BIRTH DATE*

BIRTH TIME* (AM or PM) please specify

WHAT IS THE SOURCE OF YOUR BIRTH TIME?* Memory/Birth Certificate/Other (Please specify)

CITY AND COUNTRY OF BIRTH*

WHAT DATES & TIMES WORK BEST FOR YOUR APPOINTMENT?

WHAT TIME ZONE WILL YOU BE IN AT THE TIME OF THE APPOINTMENT?

WHAT ARE YOU HOPING TO GAIN FROM YOUR ASTROLOGICAL CONSULTATION? QUESTIONS/COMMENTS

HOW DID YOU HEAR ABOUT THE 9th HOUSE?

EMAIL*

Submit

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