Astrological Coaching Request Form

Name *

This is the name we will use on your chart. Your name does not impact the reading in any way.

First Name

Last Name

Phone

This is the number we will use to call you for the consultation (unless we agree to use Skype). Landlines tend to work better than cell phones. If you only have a cell, please do just make sure you have a full charge and are in a good reception zone.

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Preferred Method of Communication for Consultation

Phone Call

Skype

Zoom

Preferred Payment Method

Payment is not required at this time. Payment is required 7 days prior to meeting. If payment is not received 7 days prior to meeting, we will reschedule your appointment.

Personal Check

PayPal Invoice Via Email

Level of Astrological Knowledge

None

Beginner

Intermediate

Advanced

Existing Client

If you are an existing client, we have your birth data on file and you do not need to send it.

Birth Date

If you prefer not to send your birth data using this form, please just let us know that in the text area below "Birth Time Unknown or Uncertain". You can leave us a voice message with your birth data at 805-409-4605. IMPORTANT: MONTH, DAY, YEAR FORMAT!

MM

DD

YYYY

Birth Time Source

Birth Certificate

Baby Book, Bracelet

Family Memory

Rectification

Unknown or Uncertain

Other