Vedic Astrology Booking Form

Vedic Astrology Booking Form - Online Reading (60 minutes)

Reboot to a Brand New You & Feel Absolutely Awesome
7-Day Detox / Fasting Retreat
Sunday January 13 - Sunday January 20, 2019

Reboot to a Brand New You & Feel Absolutely Awesome
7-Day Detox / Fasting Retreat
Sunday October 7 - Sunday October 14, 2018

How did you hear about us? *
Desired Appointment Date *
Desired Appointment Time *
Option 2 if your preferred date is not possible: *
Time *
Option 3 if your preferred date is not possible: *
Time *
	Please note - due to the popularity of these sessions we have an average 1-week lead time on all bookings.
Timezone*
First Name *
Last Name *
Gender *
Email *
Mobile Phone Number/Whatsapp *	Please include your international country code
City *
State/Prov. *
Country*
OTHER INFO:	PLEASE NOTE THIS INFORMATION IS KEPT CONFIDENTIAL!!!!
	Birth Data
Date of Birth *
Time of Birth (as accurate as possible) *

Place of Birth *
Hospital you were born in *
Source of Birth data *
	Consultation Focus
Please list the areas of your life you wish the reading to focus on. (health, wealth, spiritual path, relationships, family, personality traits, career etc) *
Any other Comments or Special Requests?