Astrology Reading Questionnaire

Please complete the form below so we can begin your Astrology Reading! Feel free to add anything you would like to share.

Name*
First Last
Birth Date*
Date Format: MM slash DD slash YYYY
Time of Birth*

: HH

MM
Birth Address*
City State / Province / Region Country
Current Address*
City State / Province / Region Country
Phone*
Email*
What is your preferred Reading format?*
What do you do for work?
Do you feel connected to your career/work?
- Yes
- No
If not, what would you love to be doing?
Please feel free to add any additional information you'd like to share about your career/work.
Do you have a significant other?
- Yes
- No
Are you happy in your relationship?
Please feel free to add any additional information you'd like to share about your relationship.
Describe your current health
Please share anything that might be relevant to your current health status.
If you have children, how is your relationship with them?
If you do not have children, would you like to?
What challenges and/or opportunities are coming up for you now?
What are you hoping to receive from our time together?*
Is there anything else you would like to focus on or let me know?