Intake form

Name

Email

Phone

Birth date

Birth time (as exact as possible)

Birth place

People present at time of birth (if known)

Whereabouts of father at time of birth (if known)

Please list 5 major events from your life and their dates (as exact as possible, or year/month). They can be moves, years of education, births, deaths, relationships, etc. I will use these to check your birth time and adjust it SLIGHTLY if it seems necessary.

Please pick a number between 1 and 108.

Most pressing question/s you have about your life at this time.

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