Request for Personal Information I’m looking forward to connecting with you soon! If this is our first session, please complete the form below to send me your birth details. You will also be able to share any questions and/or intentions you have for our time together. Name(required) Email(required) Birthdate (Month/Day/Year):(required) Birth Time (only if known): Birth Location:(required) Current Location:(required) How do you know your birth time (if given above), for example did it come from a birth certificate, parent's recollection, or some other source? Have you ever had an astrology reading before and if so, when?(required) Do you have a specific question that you would like discussed in the reading? Is there anything else you would like me to know? Submit Thank You! Thank you!