Name:
Date of birth: Time: Place:
Today’s date: Time: Place:
Aspirations / Goals:
Values / Strengths:
Challenges / Problems:
Security / Needs:
Any specific questions:
Optional (short statement about):
Life philosophy / personal spirituality:
relationships / partner and other significants:
life purpose / occupation / career:
health / wellbeing:
Interest and experience with astrology and similar:
Why now? What are your expectations for this consult?
Why me? How did you find me?