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COACHING & ASTROLOGY - REGISTRATION

Thank you for your payment!  I am excited to assist you. Please send me the following information and best answer these questions to help me assess whether my service is a match for what you are hoping for to better direct our time when we move forward to scheduling. I will contact you to schedule our appointment soon!

Note in the form below it asks for DATE and then MONTH rather than the other way around.  Just a heads-up to avoid errors :)

 

  1. First and Last Name(*)
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  2. What is your birthday?(*)
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  3. Time and place you were you born(*)
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  4. What's your current location? City, State, Country(*)
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  5. Phone number or Skype name(*)
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  6. Email(*)
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  7. Appointment Availability ( best days and times )(*)
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  8. What kind of work do you do? Do you love it? If not, what would you love to do?(*)
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  9. Are you in a relationship? Are you happy in it? What are your relationship aspirations?(*)
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  10. How is your health? Do you have any symptoms/diagnoses?(*)
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  11. Do you have children? if not, do you want to? How is your relationship with the ones you have?(*)
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  12. What are you hoping to receive from our time together?
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  13. Any other brief notes you would like to mention? Or any questions for me?
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  14. Confirmation that you have read all the details about the live 1-hour session and believe it is a match for what you are looking for.(*)
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